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Tamar gagoSiZe

bavSvis fsiqikuri ganviTarebis

darRvevebi

Tbilisi 2007

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recenzentebi:medicinis mecnierebaTa kandidati, marine gegeliSvili

naTela yuraSvili

samedicino konsultanti: medicinis mecnierebaTa kandidati, sofio kasraZe

dakabadoneba da ydis dizaini: giorgi bagrationi

© Tamar gagoSiZe, �007

gamomcemloba `nekeri~

ISBN 978-99940-986-9-9

gamomcemloba `nekeri~o. TaqTaqiSvilis ��; tel./faqsi 9�-35-�6el. fosta [email protected]

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sarCevi

Sesavali 5

ganviTarebis darRvevebis modelebi da klasifikacia 6

gonebrivi CamorCeniloba 43 daswavlis unaris darRveva 65

verbaluri daswavlis unaris darRvevebi 75

disleqsia 77

metyvelebis darRvevebi (S. mamukaZis TanamonawileobiT) 9�

yuradRebis deficitisa da hiperaqtivobis sindromi �46

autizmi �69

sxva pervesiuli aSlilobebi �99

qala-tvinis travma ��5

hidrocefalia ��6

cerebruli dambla �3�

epilefsia �4�

nayofis alkoholuri sindromi �6�

tikuri aSliloba �67

Jil de la turetis sindromi �73

qceviTi aSliloba �8�

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qromosomuli daavadebebi �97

daunis sindromi 300

viliamsis sindromi 306 myife X sindromi 3��

fenilketonuria 3�0

literatura 3�5

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Sesavali

bavSvis normaluri ganviTarebidan gadaxris identifi-kacia da prognozireba centralur problemas warmoadgens rogorc fsiqologiuri, aseve neirobiologiuri da sa-medicino mecnierebisaTvis. bavSvis ganviTarebaze mravali faqtori moqmedebs: genetikuri, biologiuri, socialuri. Sesabamisad, problemebs fsiqikur ganviTarebaSi multifaq-toruli buneba aqvs. sirTules warmoadgens is, rom gare-gnulad erTnair qceviT, kognitur Tu emociur darRvevas gansxvavebuli mizezebi SeiZleba edos safuZvlad da Tanac araerTi. SeiZleba bavSvs hqondes erTdroulad ori klini-kuri mdgomareoba. amis gamo bavSvis ganviTarebis darRvevis diagnostika sakmaod rTulia da adekvatur saklasifikacio sistemas da multidisciplinur midgomas moiTxovs. mcdari diagnozis Sedegi ki araadekvaturi mkurnaloba, bavSvis damaxinjebuli momavali da stigmatizaciaa.

bavSvis fsiqikuri ganviTarebis problemebis saidentifi-kaciod dasavleTSi xelmZRvaneloben ZiriTadad ori sakla-sifikacio sistemiT: evropaSi ICD-10-iT (International Classi-fication of Diseases da aSS-Si DSM-IV-R-iT (Diagnostic and Sta-tistical Manual). am mravalganzomilebian sistemebSi warmodge-nilia ganviTarebis darRvevebis klinikuri sindromebic.

dRes saqarTveloSi ukve daiwyo ICD saklasifikacio sistemis klinikur praqtikaSi damkvidrebis tendencia. Ses-abamisad, bavSvTa fsiqikuri ganviTarebis darRvevebis diag-nostikisas aucilebelia am saklasifikacio sistemis Sedareba DSM-IV-R-Tan da maTi Zlieri da susti mxareebis ganxilva.

DSM da ICD saklasifikacio sistemebis diagnostikur kriteriumebTan erTad klinikuri praqtikis mqone fsiqolo-gebisTvis, pediatrebisTvis, bavSvTa nevrologebisa da fsiqiatrebisaTvis mniSvnelovania ganviTarebis darRvevebis mravalferovani speqtris klinikuri, fsiqologiuri da neirofsiqologiuri niSnebis codna. es mniSvnelovanwilad zrdis diagnostikis sizustes.

aRniSnuli saxelmZRvanelo sasargeblo iqneba pirveladi jandacvis eqimebisTvis, pediatrebisTvis, bavSvTa nevrolo-gebisa da fsiqiatrebisTvis, fsiqologiis bakalavrebisa da magistrebisaTvis.

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ganviTarebis darRvevis modelebi da klasifikacia

bavSvTa fsiqopaTologiis erT-erT mniSvnelovan pro-blemas bavSvis normaluri ganviTarebidan gadaxris fsi-qologiuri kvalifikacia warmoadgens. mozrdilebisagan gansxvavebiT, bavSvis SemecnebiTi da emociuri sfero mud-mivi cvlilebebisa da Camoyalibebis procesSia, es procesi asakobrivi TaviseburebebiT xasiaTdeba. amave dros, bavSvis ganviTarebaSi metad mniSvnelovania is senzitiuri asakobri-vi periodebi, rodesac mimdinareobs Tvisobrivad axali ga-mocdilebis aTviseba da axali unarebis ganviTareba. amitom, bavSvis fsiqikuri ganviTarebis darRvevis diagnostirebisas aucilebelia normaluri ganviTarebisa da asakobrivi faqto-rebis gaTvaliswineba, radgan aRniSnulis gareSe, SeuZlebe-lia, rogorc ganviTarebis anomaliis kanonzomierebis zusti Sefaseba, klasificireba da diagnostika, ise reabilitacii-sa da swavlebis strategiis sworad SerCeva.

normaluri ganviTarebidan gadaxra xSirad ganimarteba rogorc anomaluri ganviTareba, anu dizontogenezi (norma-luri ontogenezuri ganviTarebis darRveva).

problemur ganviTarebaze moqmedi faqtorebi

cnobilia, rom bavSvis centralur nervul sistemaze rogorc biologiuri, ise fsiqo-socialuri faqtorebis xangrZlivi paTologiuri zemoqmedeba iwvevs normaluri ganviTarebidan gadaxras. ganviTarebis darRvevebi gansxva-vdeba gamomwvevi faqtorebis anu etiologiis, paTogene-zuri meqanizmebis, faqtorebis zemoqmedebis periodisa da xangrZlivobis mixedviT. amitom, ganviTarebis darRvevebis klasificireba da diagnostika SeuZlebelia ganviTarebaze moqmedi faqtorebis analizis gareSe.

ganviTarebis darRvevebis cnobil klasifikaciebSi zo-gadadaa gamoyofili bavSvis ganviTarebaze moqmedi endo-genuri da egzogenuri faqtorebi. es klasifikaciebi ufro samedicino xasiaTisaa da maTSi, ZiriTadad, ganxilulia pre-nataluri, postnataluri da perinataluri mizezebi (Han-

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dbook of Psychiatry, 1969; v. lebedinski, 1985; Developmental Disorders ed. S. Hooper, 1992). a. karis mier mowodebul ori-ginalur klasifikaciaSi (�999) bavSvis ganviTarebaze moq-med biologiur mizezebTan erTad aqcenti gamaxvilebulia mraval fsiqologiur faqtorze.

bavSvisa da mozardis fsiqologiuri problemebis ganvi-TarebaSi a. kari gamoyofs Semdeg faqtorebs:

fsiqologiuri problemebis warmomSobi predispoziciu-ri anu risk-faqtorebi;

damaCqarebeli anu biZgis mimcemi (trigerebi), an fsiqo-logiuri sirTuleebis gamaZlierebeli faqtorebi;

xelSemwyobi (SemanarCunebeli) mizezebi anu faqtorebi, romlebic xels uwyobs ukve aRmocenebuli fsiqologiu-ri problemebis gaxangrZlivebasa da ganmtkicebas;

damcavi faqtorebi, romlebic amuxruWebs aRmocenebu-li problemebis Semdgom gaRrmavebas da gavlenas axdens prognozsa Tu mkurnalobaze.

es faqtorebi or zogad sferod nawildeba: personalurad da konteqstualurad. personaluri faqtorebis qveS igulisx-meba bavSvis biologiuri da fsiqologiuri, xolo konteqstu-alurSi _ bavSvis fsiqo-socialuri garemos maxasiaTeblebi (ojaxuri, skolis, Tanatolebis, damxmare organizaciebis).

bavSvTa da mozardTa fsiqologiuri problemebis gan-mapirobebeli faqtorebis struqtura, SeiZleba, Semdegnai-rad warmovidginoT:

bavSvTa fsiqologiuri problemebis predispoziciuri, damaCqarebeli, SemanarCunebeli da damcavi faqtorebi

a. karis mixedviT (1998)

predispoziciuri faqtorebi

personaluri predispoziciuri faqtorebi

biologiuri:

genetikuri mowyvladoba;

pre- da postnataluri garTulebebi;

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adreuli asakis insultebi, travmebi da avadmyofoba.

fsiqologiuri:

dabali inteleqti;

rTuli temperamenti;

dabali TviTSefaseba;

kontrolis garegani lokusi.

konteqstualuri predispoziciuri faqtorebi

adreul bavSvobaSi bavSvi-mSoblis urTierTobis faqtorebi:

mijaWvulobis problemebi;

inteleqtualuri ganviTarebis stimulirebis nakleboba;

avtoritaruli mSoblebi;

gulgrili mSoblebi;

yvelafris nebadamrTveli mSoblebi;

araTanmimdevruli disciplina;

bavSvis adreul asakSi ojaxuri problemebis arseboba

mSoblebis fsiqologiuri problemebi;

mSoblebis alkoholozmi da narkomania;

mSoblebis kriminaluroba;

col-qmruli uTanxmoebani da Zaladoba;

ojaxuri dezorganizacia;

deliqvanturi da-Zma.

adreuli bavSvobis stresi;

ganSoreba;

axloblis dakargva;

Zaladoba;

institucionaluri aRzrda;

araxelsayreli socialuri pirobebi.

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damaCqarebeli faqtorebi

mwvave cxovrebiseuli stresi;travma, avadmyofoba;Zaladoba;cema;axloblis dabadeba an dakargva;cxovrebiseuli ciklis gardamavali periodebi;skolis gamocvla;Tanatolebis an megobrebis dakargva;axloblebTan ganSoreba an mSoblebis gayra;mSoblebis umuSevroba;sacxovrebeli adgilis gamocvla;

ekonomikuri sirTuleebi.

SemanarCunebeli faqtorebi

personaluri SemanarCunebeli faqtorebi

biologiuri faqtorebifsiqofiziologiuri sistemebis dezintegracia

fsiqologiuri faqtorebidabali TviT-efeqturoba;disfunqciuri atribuciuli stili;dacvismoumwifebeli meqanizmebi;disfunqciuri daZlevis strategiebi.

konteqstualuri SemanarCunebeli faqtorebi

mkurnalobis sistemis faqtorebi:ojaxis mier problemis ignorireba;problemis gadawyvetisadmi ambivalenturoba;problemasTan gamklavebaSi ojaxis gamoucdeloba;ojaxis mier diagnozisa da mkurnalobis dagegmvis uar-

yofa;mkurnalobaSi CarTul profesionalebs Soris koordi-

naciis ararseboba.

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ojaxis sistemis faqtorebi:problemuri qcevis uneblie ganmtkiceba;aramdgradi mijaWvuloba;Zaladobrivi urTierToba da avtoritaruli aRzrda;ojaxis gaTiSuloba da problemisadmi gulgrili da-

mokidebuleba;Warbi mzrunveloba da yvelafris nebadamrTveli aRzr-

da;araTanmimdevruli disciplina;bundovani komunikacia ojaxis wevrebs Soris;triangulacia;qaoturi ojaxi;col-qmruli uTanxmoebani;arasruli ojaxi, mSoblebis ganqorwineba.

mSoblebis faqtorebi:mSoblebs msgavsi problema aqvT;mSoblebis fsiqologiuri problemebi an kriminaluroba;bavSvis ganviTarebisadmi araadekvaturi molodinebi;mSoblebis dabali TviTSefaseba;mSoblebis kontrolis garegani lokusi;mSoblebis dabali TviT-efeqturoba;depresiuli an negatiuri atribuciuli stili;moumwifebeli dacvis meqanizmebi;disfunqciuri daZlevis strategiebi;

socialuri kavSirebis faqtorebi:mwiri socialuri mxardaWera;Zlieri ojaxuri stresi;socialuri warumatebloba;bavSvisaTvis araadekvaturi saganmanaTleblo sivrce;dasaqmebis mcire SesaZlebloba;Zaladoba sainformacio saSualebebSi.

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damcavi faqtorebi

personaluri damcavi faqtorebi

biologiuri faqtorebi:kargi fizikuri janmrTeloba;

fsiqologiuri faqtorebiinteleqtis maRali koeficienti;axal garemosTan ioli adaptacia;maRali TviTSefaseba;kontrolis Sinagani lokusi;maRali TviT-efeqturoba;optimisturi atribuciuli stili;dacvis momwifebuli meqanizmebi;daZlevis funqciuri strategiebi.

konteqstualuri damcavi faqtorebimkurnalobis sistemis faqtorebi:ojaxis mier problemis mimRebloba;ojaxis mier problemis gadawyvetaze valdebulebis aRe-

ba;ojaxis msgavs problemasTan gamklavebis gamocdileba;ojaxis mier diagnozisa da mkurnalobis gegmis mimReb-

loba;ojaxsa da profesionalebs Soris kargi koordinacia.

ojaxis sistemis faqtorebi:usafrTxo mijaWvuloba;avtoritaruli aRzrda;mkafio, cxadi ojaxuri komunikacia;moqnili ojaxuri organizacia;mamis CarTuloba;col-qmruli Tanxmobisa da kmayofilebis maRali xarisxi.

mSoblebis faqtorebi:bavSvis ganviTarebisadmi adekvaturi molodinebi;mSoblebis adekvaturi TviTSefaseba;mSoblebis kontrolis Sinagani lokusi;mSoblebis maRali TviT-efeqturoba;

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optimisturi atribuciuli stili;momwifebeli dacvis meqanizmebi;funqciuri daZlevis strategiebi.

socialuri kavSirebis faqtorebi:Zlieri socialuri mxardaWera;bavSvisaTvis adekvaturi saganmanaTleblo sivrce;maRali socio-ekonomikuri statusi.

asakobrivi ganviTarebis maxasiaTeblebisa da ganviTarebis darRvevis simptomebis mimarTeba

ganviTarebis darRvevis diagnostirebisas didi mniSvne-loba aqvs dizontogenezis simptomebisa da normaluri gan-viTarebis asakobrivi niSnebis diferencirebas. normaluri ganviTarebis sxvadasxva periodSi bavSvi gansxvavebulad reagirebs garemos mavne zemoqmedebaze. bunebrivia, ganvi-Tarebis darRvevis SemTxvevaSic, dizontogenezis simpto-mebTan erTad, saxezea bavSvis asakobrivi ganviTarebisaTvis damaxasiaTebeli niSnebic.

ganasxvaveben nervul-fsiqikuri reagirebis oTx tips (v. kovaliovi, �979):

reagirebis somato-vegetaturi done (0-3 weli) _ xasiaT-deba vegetaturi simptomebiT, rogoricaa Zilis, madis, kuW-nawlavis funqcionirebis darRvevebi, sxeulis tem-peraturis mateba;

reagirebis fsiqomotoruli done (4-�0 weli) _ xasiaTde-ba sxvadasxva warmoSobis hiperdinamikuri tipis darRve-vebiT, rogoricaa fsiqomotoruli agzneba, tikebi, ena-borZikoba, enurezi;

reagirebis afeqturi done (7-�� weli) _ xasiaTdeba sxva-dasxva saxis SiSebiT, ioli afeqturi agznebadobiT, ne-gativizmisa da agresiis gamovlinebebiT;

reagirebis emociur-ideatoruli done (��-�6 weli) _ xa-siaTdeba pubertatis asakisaTvis Cveuli Taviseburebe-biT.

reagirebis aRniSnuli doneebi, rogorc wesi, konkretul

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asakobriv periodebs Seesabameba, Tumca, yovel asakobriv jgufSi, SesaZlebelia, met-naklebi xarisxiT gamovlindes reagirebis oTxive done. amitom garemos mavne zemoqmede-baze reagirebis zemoaRniSnuli tipiT dayofa pirobiTia, radgan aseT SemTxvevebSi asakis Sesabamisi reagirebis tipis upiratesobazea saubari. ganviTarebis darRvevebis Sefase-bisas, aseve, mniSvnelovania kritikuli asakobrivi periode-bisaTvis damaxasiaTebeli Taviseburebebis gaTvaliswinebac; kritikuli, krizisuli anu senzitiuri periodi warmoad-gens ganviTarebis erTi safexuridan meoreze gadasvlis Sualedur stadias. am dros Cndeba bavSvis ukve SeZenil, dauflebul unarebsa da garemos gazrdil moTxovnebs So-ris konfliqti. garemosTan bavSvi ukve veRar urTierTobs Zveli saSualebebiT, axali unarebi ki jer isev Camoyali-bebis procesSia. aseT SemTxvevebSi, SeiZleba, regresi, anu wina asakobriv safexurze droebiTi Camocurebis fenomeni ganviTardes. normaluri ganviTarebis es kanonzomiereba aucileblad unda iqnas gaTvaliswinebuli anomaluri gan-viTarebis Sefasebis dros.

bavSvis fsiqikuri funqciebis da unarebis normaluri ganviTarebis kanonzomiereba da darRveva

funqciis da ganviTarebis Sefasebisas didi mniSvneloba aqvs fsiqikuri unaris Camoyalibebis procesis romel eta-pze moxda mavne zemoqmedeba. amis mixedviT SesaZlebelia imis dadgena, Tu ganviTarebis ra saxis anomaliasTan SeiZle-ba gvqondes saqme. fsiqikuri funqciis da unaris momwifebis sami ZiriTadi etapi gamoiyofa: aRmoceneba, Camoyalibeba da ganmtkiceba (Dennis, Burnes, 1994). unaris momwifebaSi Sesa-Zlebelia gamodiferencirdes Semdegi aspeqtebi:

aRmoceneba:aRmocenebis dro – ganviTarebis is etapi, rodesac pir-

velad vlindeba konkretuli unari. is SeiZleba iyos drouli an dagvianebuli.

Tanmimdevroba – unaris aRmocenebis dro sxva unareb-Tan mimarTebaSi: ra TanmimdevrobiT xdeba konkre-tuli unaris pirveli gamovlineba. is SeiZleba iyos

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normaluri an darRveuli, rac gulisxmobs unaris aRmocenebis Tanmimdevrobis arevas sxva unarebTan mimarTebaSi.

ganviTareba:Camoyalibebis tempi – unaris ganviTarebis siswrafea.

is SeiZleba iyos normaluri, an droSi gaxangrZli-vebuli.

strategia – unaris gamoyenebis gza da saSualebebi. is SeiZleba iyos Cveuli, normaluri an SemovliTi, rac gulisxmobs unaris gamoyenebis atipur, araefeqtur gzas.

gavarjiSeba – gulisxmobs saboloo kompetenciis mi-Rwevas, rodesac unaris funqcionireba Sedegiania da did Zalisxmevas aRar moiTxovs. is SeiZleba iyos normaluri an deficituri – am dros ar xdeba una-ris sruli Camoyalibeba da mis ganxorcielebas didi Zalisxmeva esaWiroeba.

ganmtkiceba:kontroli – unaris kontroli gulisxmobs mis srulad

gamoyenebis SesaZleblobas mokle droSi Seferxebis gareSe. kontroli SeiZleba iyos normaluri an simp-tomuri, rac miuTiTebs unaris droebiT daqveiTeba-sa da darRvevaze.

SenarCuneba – gulisxmobs unaris xangrZlivad Senaxva-sa da gamoyenebas. is SeiZleba iyos normaluri an darRveuli, rac miuTiTebs imaze, rom ver xerxdeba ganviTarebuli unaris xangrZlivad Senaxva.

ganviTarebis darRvevis diagnostikisaTvis Zalian mniS-vnelovania imis garkveva, Tu ra periodSi aRiniSna ama Tu im unaris asakisaTvis Seusabamo ganviTareba da ra iyo misi qceviTi gamovlinebebi. es gvaZlevs informacias bavSvis ara mxolod deficitis, aramed misi SesaZleblobebis Sesaxeb da meores mxriv gvexmareba diagnostikuri kriteriumebis adekvaturad gamoyenebaSi.

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ganviTarebis fsiqopaTologiis modelebi

ganviTarebis fsiqopaTologiis mravalferovani Teorie-bidan sami ZiriTadi prototipuli modelia gamoyofili: niS-nebis modeli, garemos modeli da interaqciuli modeli.

ganviTarebis darRvevebis etiologiisa da paTogenezis mixedviT es modelebi mravali variaciis saxiT gvxvdeba.

niSnebis anu statusis models samedicino modelsac uwodeben. misi ZiriTadi debuleba SemdgomSi mdgomareobs: drois konkretuli periodisaTvis arsebuli niSnebiTa da statusiT SesaZlebelia bavSvis Semdgomi periodis statu-sis winaswarmetyveleba. es modeli ar aris interaqciuli tipis da, aqedan gamomdinare, garemos gavlenis efeqts ar ganixilavs. am modelSi ganixileba iseTi SemTxvevebi, ro-desac garkveuli niSani SeiZleba kidec urTierTqmedebdes garemosTan, magram igi garemos gavleniT ar icvlebodes. niSnebis transformacia rTuli fenomenia. niSnebi, SeiZle-ba, moicavdes procesebs, daZlevis unarebs, reagirebis ten-denciebs, temperaments, genetikur kodebs da a.S. amasTan, niSnebi, SeiZleba, swavlis procesSi iqnas SeZenili interaq-ciis Sedegad. SeZenis Semdeg igi SedarebiT ucvlelad rCeba da Semdegi interaqciis mere ar xdeba misi transformacia.

genetikuri da biologiuri mizezebis Sedegad aRmocene-buli fsiqopaTologiuri problemebis gasarkvevad efeq-turia niSnebis modeli da mas xSirad iyeneben fsiqikuri daavadebebis genetikuri mizezebis kvlevisas. konkretuli niSani paTologiis konkretuli tipis gamomwvevia. bavSvs, romelic erTi an ramdenime genis cvlilebiTaa dabadebu-li, fsiqopaTologiis niSnebi mogvianebiT uvlindeba. am SemTxvevaSi potenciur Sedegebze garemos zegavlenis roli umniSvneloa. am models naklic gaaCnia:fsiqopaTologia SeiZleba ar gamovlindes im pireb-

Si, romlebic konkretuli statusis, an niSnis matare-belni arian. mag.: SizofreniiT daavadebuli mSoblebis Svils Sizofrenia, SeiZleba, ar ganuviTardes; myife X sindromis mqone qalebs, SeiZleba, ar gamouvlindeT darRvevebi, iseve, rogorc fenilketonuriis genuri mutaciis mqone yvela pirs, SeiZleba, ar aReniSnos fsiqopaTologia an ganviTarebis problemebi.

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garemos modeli. qcevaze gavlenas axdens warsuli ga-mocdilebac. drois konkretul momentSi zogierTi garemo faqtori mniSvnelovnad moqmedebs qcevaze. magaliTad, ad-reuli asakis periodSi garemos negatiuri gavlena bevrad mniSvnelovania, vidre mogvianebiT asakSi. aseve, bavSvis gan-viTarebaze mastimulirebeli da yuradRebiani garemo da-badebidan pirvel wels ufro dadebiTad moqmedebs, vidre meore wels. bavSvis konkretuli gamocdileba SemdgomSi ax-dens gavlenas mis qcevasa da garemosadmi reagirebaze.

interaqciuli modeli. am modelis mixedviT (Lewis, 1972; Sameroff, Chandler, 1975) bavSvis ganviTarebaze gavlenas ax-dens rogorc garemo, aseve bavSvisTvis damaxasiaTebeli niS-nebi. bavSvis ganviTarebaSi cvlileba am ori faqtoris funq-ciaa. ganviTarebis aRniSnuli modelis centraluri sakiTxia transformacia. ganarCeven interaqciuli modelis or vari-ants. pirvel SemTxvevaSi axal qcevebs niSnisa da garemos urTierTqmedeba iwvevs da am urTierTqmedebis Sedegad ar icvleba arc niSani, arc garemo. am modelis mixedviT axa-li qcevebi aRmocendeba Zveli qcevebisa da garemosTan maTi interaqciis safuZvelze; magram, es mxolod axali qcevebis Zvel repertuarze damatebaa. meore SemTxvevaSi axali qce-vebi aRmocendeba garemosa da niSnis urTierTqmedebiT, ris Sedegadac icvleba rogorc garemo, ise niSani. am ukanasknel midgomas l. vigotskis modeli (�98�) ekuTvnis.

morgebis modeli (Thomas, Chess, 1977; Lerner, 1984). am modelis ZiriTadi debulebis safuZvelia bavSvis proble-mebis maxasiaTeblebsa da garemos moTxovnebs Soris Seu-Tavsebloba. Seguebis problemebi ara bavSvis bunebaSi, an garemos moTxovnebSia, aramed maT SeuTavseblobaSi. morge-bis modelis mixedviT fsiqopaTologia bavSvis niSnebisa da garemos Seusabamobis Sedegs warmoadgens.

l. vigotskis modeli. anomaluri ontogenezuri ganviTa-rebis Sesaswavlad gadamwyveti mniSvneloba aqvs ganviTare-bis ori faqtoris _ biologiurisa da socialur-fsiqolo-giuris urTierTmoqmedebis gaTvaliswinebas. ganviTarebis procesSi icvleba fsiqikuri aqtivobis uzrunvelyofis nervuli meqanizmebi, xolo biologiuri da socialur-fsiqologiuri faqtorebis urTierTqmedeba cvlis bavSvis

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qcevas; bavSvis gamocdileba icvleba garemosTan aqtiuri urTierTmoqmedebis procesSi.

v. lebedinskim l. vigotskis debulebebze dayrdnobiT gamoyo fsiqikuri ganviTarebis darRvevis ganmsazRvreli Semdegi parametrebi:

• darRvevis funqciuri lokalizacia. lokalizaciis mi-xedviT gamoiyofa kerZo da zogadi deficiti. kerZo deficiti fsiqikuri funqciebis (gnozisis, praqsisis, metyvelebis), xolo zogadi deficiti regulatoruli sistemebis darRvevas gulisxmobs, rac fsiqikuri aq-tivaciis donis, yuradRebis koncentraciis, emociuri sferos regulaciis, moqmedebis dagegmvisa da kontro-lis darRvevebSi vlindeba.

• dazianebis dro. ganviTarebis darRvevis tipi damokide-bulia nervuli sistemis dazianebis periodze. droiTi faqtoris qveS ara mxolod dazianebis momenti, aramed ontogenezSi mocemuli funqciis ganviTarebis perio-dis xangrZlivobac igulisxmeba. bavSvis ganviTarebis procesSi fsiqikuri funqciebis CamoyalibebisaTvis gan-sxvavebuli droa saWiro. zogierT funqcias ganviTare-bis xanmokle cikli aqvs, zogs ki - xangrZlivi. ase rom, ontogenezSi fsiqikuri funqciebi heteroqronulad vi-Tardeba anu funqciaTa Camoyalibeba erTdroulad ki ar xdeba, aramed, TiToeul maTgans ganviTarebis misTvis da-maxasiaTbeli droiTi cikli aqvs. magaliTad, motoruli funqciis Camoyalibebas xangrZlivi periodi sWirdeba _ dabadebidan 7 wlamde, maSin, roca mxedvelobiTi da taq-tiluri aRqmis Camoyalibebis cikli ufro xanmoklea _ 3 wlamde. amave dros, ganviTarebis yovel etapze romeli-me fsiqikuri funqciis Camoyalibeba droSi win uswrebs sxva funqciebis ganviTarebas. mag.: ontogenezis adreu-li periodis wamyvani funqciaa aRqmisa da metyvelebis ganviTareba da am funqciebis Camoyalibeba win uswrebs praqsisis ganviTarebas. ganviTarebis adreul safexurze aRqmis wamyvani roli piaJes cnobil fenomenebSi vlin-deba. SemdgomSi mimdinareobs sagnobrivi moqmedebebis unarisa da praqsisis ganviTareba. motorul aqtivobaSi sityvis maregulirebeli rolis gazrda iwvevs aRqmis,

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metyvelebis, nebiT motorul qmedebaTa Soris funqci-uri urTierTobis mniSnvnelovan cvlilebas.drois parametrSi, aseve, igulisxmeba ganviTarebis sen-

zitiuri periodebic. garemos mavne zemoqmedebis mimarT zRurbli gansakuTrebiT dabalia 0-3 wlamde da ��-�5 wlis asakSi. am periodebSi gansakuTrebiT xSiria regresis mov-lena. regresi SeiZleba ganicados ara mxolod Camoyalibe-bis procesSi myofma, aramed ukve Camoyalibebulma funq-ciebmac. aucilebelia regresis movlenisa da ganviTarebis darRvevis gansxvaveba, radganac pirvel SemTxvevaSi funq-ciis ganviTarebis wina doneze gadasvla xdeba, xolo meore SemTxvevaSi _ funqciis uxeSi, an nawilobrivi darRveva.

ganviTarebaSi CamorCena arasdros araa erTnairi. nervu-li sistemis dazianeba, pirvel rigSi, im fsiqikuri funq-ciebis ganviTarebis darRvevas iwvevs, romlebic am konkre-tul momentSi imyofeba Camoyalibebis senzitiur periodSi da gansakuTrebulad mowyvladia.

• urTierTmimarTeba pirvelad da meorad defeqtebs Soris.l. vigotskis mixedviT defeqts sistemuri agebuleba aqvs. pirveladi defeqti uSualod ukavSirdeba anomaluri ganvi-Tarebis biologiur faqtorebs (mag. smenis da mxedvelobis dazianeba, bavSvTa cerebruli dambla, genetikuri darRve-vebi, Tavis tvinis dazianeba da a.S.); meoradi defeqti ki pir-veladi defeqtiT ganpirobebuli anomaluri ganviTarebis procesis Sedegia. mag.: smenis daqveiTeba SeiZleba iyos pir-veladi defeqti, xolo meoradi defeqtis saxiT warmoCinde-ba metyvelebis ganviTarebis problemebi da komunikaciuri funqciis darRveva. meoradad SeiZleba dairRves is fsiqi-kuri funqciebic, romlebic dazianebis momentSi ganviTa-rebis senzitiur periodSi imyofeba. mag.: skolamdel asakSi gansakuTrebiT mowyvladia nebiTi motorika da metyveleba, amitom sxvadasxva dazianebisa da gansxvavebuli pirveladi defeqtebis SemTxvevaSi xSiria maTi ganviTarebis darRveva.

• funqciaTaSorisi kavSirebis darRveva. ontogenezSi fun-qciebi ara izolirebulad, aramed erTmaneTTan urTier-TkavSirSi viTardeba. normaluri ganviTarebis procesSi funqcias, SeiZleba, ramdenime saxis kavSiri hqondes sxva funqciebTan:

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�. funqciis droebiTi damoukideblobiT xasiaTdeba onto-genezis adreuli etapi. magaliTad, l. vigotskis mixed-viT, � wlamde asakis bavSvebSi metyvelebisa da azrovne-bis ganviTareba erTmaneTisagan damoukideblad mimdi-nareobs, aseve erTmaneTisagan damoukidebelia metyve-lebis fonetikuri da azrobrivi mxareebis ganviTarebis procesebic.

�. funqciis asociaciuri kavSirebic ganviTarebis adreul etapebs axasiaTebs. drosa da sivrceSi siaxlovis mixed-viT, sxvadasxva modalobis STabeWdilebebi erT mTlian asociaciur kompleqsebad erTiandeba. SeiZleba, es aso-ciaciuri kompleqsebi sxvadaxva sirTulis iyos, Tumca, aseTi saxis kavSirebi fsiqikuri funqciebis sust dife-renciaciaze miuTiTebs.

3. funqciaTa Soris ierarqiuli kavSirebi yalibdeba sag-nobrivi moqmedebebis dauflebisa da socialuri ur-TierTobis procesSi. funqciaTa Soris ierarqiuli da mravaldoniani kavSirebi gulisxmobs funqciis wamyvani, maregulirebeli da fonuri, teqnikuri doneebis gamo-diferencirebas; funqciis ganxorcielebaSi yovel maT-gans Sesatyvisi daniSnuleba gaaCnia.

normaluri sistemogenezis pirobebSi saxezea yvela ti-pis kavSiri, romlebic asaxaven fsiqikuri funqciebis fun-qciuri organizaciis sxvadasxva doneebs. fsiqikuri funq-ciebis garTuleba Tu funqciuri struqturis Secvla ga-rkveuli qronologiuri TanmimdevrobiT mimdinareobs da heteroqroniis kanons emorCileba.

ganviTarebis daRvevisas adgili aqvs funqciaTa Soris kavSirebis darRvevas. mag.: rodesac funqcia mowyvetilia sxva fsiqikur funqciebs da damoukideblad viTardeba, funqciis droebiT damoukideblobas misi izolirebuli ganviTareba cvlis. ganviTarebis darRvevis dros asocia-ciuri kavSirebi maRali inertulobiT xasiaTdeba, ris Se-degadac xdeba maTi paTologiuri fiqsacia, veRar xerxdeba funqciis garTuleba da misi ierarqiul kavSirebSi CarTva. irRveva funqciaTa ganviTarebis heteroqronulobis kanoni da adgili aqvs asinqronias, anu ganviTarebis dispropor-cias; erTi funqciis ganviTarebis ciklis darRveva iwvevs

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sxva fsiqikuri funqciebis ganviTarebis deficits. SeiZle-ba, adgili hqondes ganviTarebis calkeuli periodis Camor-Cenas anu retardacias; an calkeuli funqciebis naadrev, izolirebul ganviTarebas _ aqseleracias.

aRniSnuli meqanizmebi mniSvnelovan rols asruleben sxvadasxva saxis ganviTarebis darRvevis CamoyalibebaSi.

ganviTarebis fsiqopaTologiis Sefaseba

ganviTarebis darRvevebis diagnostikaSi centralur sakiTxs warmoadgens bavSvTa problemebisa da SesaZleblo-bebis Sefaseba. Sefasebis proceduris dros xdeba darR-vevis tipis gansazRvra, bavSvis individuri problemis identifikacia, intervenciis (Carevis) SerCeva da Sedegebis ganWvreta.

imis mixedviT, Tu visTan urTierTobs, bavSvis qceva icv-leba situaciurad. amitom, SefasebisaTvis mxolod erTi proceduris gamoyeneba ar iqneba marTebuli; bavSvis Sefa-sebisas aseve mizanSeuwonelia informaciis mxolod erTi wyaros gamoyeneba. informaciis miReba metad mniSvnelova-nia im pirebisgan, vinc sxvadasxva situaciaSi da pirobebSi urTierTobs bavSvTan. amave dros, aucilebelia, Sefasebis, rogorc mravalganzomilebiani sistemis gansazRvra, romlis mizania sxvadasxva sferoSi da pirobebSi bavSvis susti da Zlieri mxareebis identifikacia. aseTi mravalmxrivi Sefa-seba saSualebas iZleva davinaxoT Tu intervenciis rogori saxea saWiro mocemul konteqstSi. erTsa da imave bavSvTan intervenciis tipis SerCeva konteqstis gaTvaliswinebiT unda moxdes. b. aSenbaxi bavSvis damakmayofilebeli Sefase-bis mizniT gamoyofs 5 ganzomilebas. TiToeuli ganzomile-bis farglebSi gamoiyeneba Sesabamisi instrumentebi. aRsa-niSnavia, rom ganviTarebis sxvadasxva periodisaTvis yvela ganzomileba Tanabrad mniSvnelovani ar aris.

mravalganzomilebiani Sefasebis modeli gulisxmobs: mSoblis angariSs, maswavleblis angariSs, kognitur Sefase-bas, fizikur Sefasebasa da uSualod bavSvze dakvirvebas.

bavSvis Sefasebis mizania misi sirTuleebisa Tu poten-

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ciuri SesaZleblobebis identifikacia da daxmarebis stra-tegiis gansazRvra. raime sistemis mixedviT identifikaciis nebismieri forma sxvadasxva mdgomareobis erTmaneTisagan gansxvavebis mizniT kategorizaciasa da klasifikacias efu-Zneba. amitom, bavSvis mdgomareobis identifikacia da misi sxva bavSvis mdgomareobisagan gansxvaveba SeuZlebelia kla-sifikaciis gareSe. klasifikacia ki mxolod konkretuli kriteriumebis safuZvelzea SesaZlebeli da taqsonomias gulisxmobs.

taqsonomia klasifikaciis mecnierebaa, romelic ga-rkveuli wesiT jgufis elementebis (taqsonebis) qvejgufe-bad (taqsebad) gamoyofas gulisxmobs ise, rom am qvejgufebs mkafio sazRvrebi hqondes da sxvadasxva qvejgufSi Semavali elementebi ar faravdnen erTmaneTs. praqtikaSi taqsonomia unda iyos martivi da advilad gamosayenebeli.

klasifikaciis funqciaadamianis ganviTarebis darRvevebis klasifikacias Sem-

degi daniSnuleba aqvs:

• uzrunvelyofs Teoriis, gagebisa da axsnis safuZvlebs;

• aRwers mdgomareobas da xels uwyobs mis Sesaxeb infor-maciis Sekrebas;

• uzrunvelyofs standartul leqsikons, saxeldebis sa-erTo sistemas movlenebis, niSnebisa da simptomebis aR-saniSnavad;

• gansazRvravs cxovrebiseul movlenebsa da darRveul mdgomareobebs Soris kavSirs;

• axdens mdgomareobis winmswrebi da Semdgomi movlenebis identifikaciasa da xels uwyobs mkurnalobis tipis gan-sazRvras;

• iZleva prognozisa da mdgomareobis kontrolis saSua-lebas.

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midgomebi Sefasebisadmi

ganasxvaveben klasifikaciis aRweriT, diagnostikur da multivariaciul midgomebs. maT Sesafaseblad yvela SemTxvevaSia aucilebeli im kriteriumebis gaTvaliswineba, romelTa safuZvelzec fasdeba aRniSnuli midgoma.

diagnostika xorcieldeba simptomebis, niSnebis aRwe-riT da am simptomebis konkretul sindromSi gaerTiane-biT. es procesi sakmaod rTulia, radgan msgavsi simptomebi axasiaTebs gansxvavebul sindromebs. diagnostirebisaTvis saWiroa im saerTo faqtoris moZieba, romelic simptomebs sindromSi gaaerTianebs da konkretuli diagnozis far-glebSi moaqcevs. diagnozi warmoadgens mdgomareobis Sesa-xeb daskvnas sisworis garkveuli albaTobis xarisxiT, rac damokidebulia aRniSnuli mdgomareobis Sesaxeb codnasa da empiriul faqtebze. sityva `diagnozi~ berZnuli sityvaa da niSnavs `gansxvavebas~ an `ors Soris garCevas~.

diagnostikuri daskvnebi validuri, anu vargisiani unda iyos, Sesabamisad unda arsebobdes maTi validobis dadgenis gzebi. rodesac diagnozis dadgena safexurebrivad xdeba da mkurnaloba iniSneba, aucilebelia, rom igi moicavdes misi winmswrebi movlenebisa da gamowveuli Sedegebis aRweras; Sesa-bamisad, diagnostikuri procesi Semdeg nabijebs gulisxmobs:

• mdgomareobis `paTogenezis~ an etiologiis aRwera _ identifikacia, Tu rogor da ra mizeziT aRmocenda mdgomareoba;

• mdgomareobis ganviTarebis SesaZlebeli mimarTulebis gansazRvra;

• diagnozi _ daskvna mocemuli mdgomareobis Sesaxeb, imis gansazRvra, Tu ra daavadeba aqvs pacients;

• mkurnalobis gansazRvra konkretuli mdgomareobis gaumjobesebis mizniT;

• prognozi _ rogor ganviTardeba mdgomareoba mkur-nalobis fonze da misi Sewyvetis Semdeg;

• adekvaturi mkurnalobis gagrZeleba;

• diagnozis Semowmeba Sedegebis SefasebiT.

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aRweriTi midgoma

amJamad gavrcelebulia ori saerTaSoriso sadiagnos-tiko sistema _ DSM-IV, amerikuli da ICD-10, saerTaSoriso, SemuSavebuli jandacvis msoflio organizaciis mier.

DSM-IV mravalganzomilebiani kategorialuri sistemaa. sxvadasxva mdgomareobis ganmasxvavebeli simptomebi da niS-nebi 5 ganzomilebazea aRwerili.

I ganzomileba _klinikuri sindromebi. am ganzomilebaze aR-werilia sxvadasxva fsiqiuri aSlilobebi da maTi diag-nostikuri kriteriumebi garda pirovnuli aSlilobebisa da gonebrivi CamorCenilobisa.

II ganzomileba _ pirovnuli aSlilobebi; gonebrivi CamorCe-niloba. am ganzomilebaze aRwerilia pirovnuli aSlilo-bebi da gonebrivi CamorCenilobis diagnostikuri krite-riumebi xarisxebis mixedviT.

III ganzomileba _ zogadi samedicino mdgomareoba. am ganzo-milebaze mocemulia sxvadasxva daavadebebi, romlebic ar klasificirdeba rogorc fsiqiuri aSliloba. amave dros, mravali somaturi Tu nervuli daavadeba SeiZleba mniS-vnelovan kavSirSi iyos sxvadasxva saxis fsiqiur aSlilo-basTan.

IV ganzomileba _ garemos da fsiqosocialuri problemebi. am ganzomilebaze aRwerilia is fsiqosocialuri prob-lemebi, rac SeiZleba kavSirSi iyos fsiqiur aSlilobasTan an gavlena moaxdinos mis mkurnalobasa da prognozze.

V ganzomileba _ funqcionirebis globaluri Sefaseba (adaptaciis xarisxi). am ganzomilebaze fasdeba individis zogadi funqcionirebis done, rac moicavs fsiqologiur, socialur da dasaqmebis aspeqtebs.

bavSvTa da mozardTa darRvevebi, iseve rogorc sxva ZiriTadi diagnozebi garda gonebrivi CamorCenilobisa aR-werilia I ganzomilebaze.

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Cvilobis, bavSvobisa da mozardobis asakis ZiriTadi darRvevebi DSM-IV-is mixedviT:

gonebrivi CamorCeniloba: (moTavsebulia II ganzomilebaze)

317. msubuqi _ saSualoze mniSvnelovnad dabali inteleqti IQ-50-70, Tumca SeuZlia garemos socialur moTxov-nebTan gamklaveba.

318.0 saSualo _ saSualoze mniSvnelovnad dabali intele-qti IQ-35-55, esaWiroeba perioduli daxmareba.

318.1 Zlieri _ saSualoze mniSvnelovnad dabali inteleqti IQ-20-35, esaWiroeba mudmivi daxmareba, SeuZlia elemen-taruli Cvevebis daswavla;

318.2 mZime _ �0-ze dabali IQ; esaWiroeba movla da mudmivi zedamxedveloba.

319. gonebrivi CamorCeniloba, simZimis dadgena SeuZlebelia

ganviTarebis pervesiuli darRvevebi

299.00 autizmi _ komunikaciuri Cvevebis darRveva, socia-luri urTierTobebisa da qcevis darRveva, afeqturi sferos darRveva da garemos mimarT gulgriloba, rac vlindeba dabadebidan 30 Tvemde;

299.80 retis sindromi;

299.10 bavSvobis dezintegraciuli aSliloba;

299.80 aspergeris sindromi;

299.80 ganviTarebis pervesiuli darRveva (dauzustebeli), ro-melic ar Tavsdeba autizmis kriteriumebSi.

daswavlis unaris darRvevebi

315.00 kiTxvis unaris ganviTarebis darRvevebi _ kiTxvis mwiri Cvevebi, rac ar aris gamowveuli gonebrivi CamorCeni-

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lobiT; kiTxvis Cvevebis aTvisebis gaZneleba, enobrivi da metyvelebis darRvevebi;

315.1 maTematikuri unaris ganviTarebis darRveva _ mwiri ariTmetikuli Cvevebi, rac ar aris gamowveuli gone-brivi CamorCenilobiT an sxva faqtorebiT; ariTmetikis aTvisebis gaZneleba;

315.2 weris unaris ganviTarebis darRvevebi _ mwiri weriTi Cvevebi, rac ar aris gamowveuli gonebrivi CamorCeni-lobiT; weris aTvisebis gaZneleba;

315.9 daswavlis unaris daqveiTeba - yvela sxva, dauzustebeli.

komunikaciis darRvevebi

315.31 eqspresiuli metyvelebis darRveva _ azris gamoTqmis gaZneleba da sityvebis simwire;

315.32 Sereuli impresiuli (receptuli)-eqspresiuli metyve-lebis darRveva _ metyvelebis gagebis da azris sityveb-Si Camoyalibebis simwire;

315.39 fonologiuri darRveva (artikulaciis ganviTarebis darRveva) _ artikulaciis gaZneleba, bgerebis mwiri ar-tikulacia, rac ar aris dakavSirebuli sxva klinikur mdgomareobebTan;

307 enaborZikoba

307.9 komunikaciis sxva, dauzustebeli darRvevebi.

motoruli Cvevebis darRveva

315.4 koordinaciis ganviTarebis darRveva _ moZraobaTa koordinaciis simwire;

yuradRebis deficitisa da qceviTi aSliloba

314.XX yuradRebis deficitisa da hiperaqtivobis sindromi _ asakTan Seusabamo uyuradReboba, impulsuroba, hipe-

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raqtivoba;

314.01 kombinirebuli tipi;

314.00 upiratesad uyuradRebo tipi;

314.01 upiratesad impulsuri tipi;

314.9 yuradRebis deficitisa da hiperaqtivobis darRveva _ yvela sxva, dauzustebeli.

312. XX qceviTi aSliloba _ qcevis darRvevis mudmivi ga-movlineba, rodesac sxvebis uflebebi da socialuri normebi sistematurad irRveva; vlindeba agresiis saxiT jgufebSi da individurad;

312.81 dasawyisi bavSvobaSi

312.82 dasawyisi ymawvilobaSi

312.89 dasawyisis gansazRvra SeuZleblia

313.81 opoziciuri devianturi aSliloba _ negatiuri da mav-ne qcevis gamovlineba socialuri normebis darRvevis gareSe.

312.9 qcevis sxva, dauzustebeli aSliloba

kvebiTi aSliloba

52.52 pika _ arasakvebi nivTierebebis mudmivad sakvebad gamoyeneba;

307.53 Cvilobis ReWvis darRveva;

307.59 Cvilobis da bavSvobis kvebis sxva, dauzustebeli aSli-lobebi.

sqesobrivi identifikaciis aSliloba

302.6 bavSvobis sqesobrivi identifikaciis aSliloba _ sqe-sTan dakavSirebuli intensiuri distresi da misi Se-cvlis survili;

302.6 sqesobrivi identifikaciis sxva darRvevebi

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tikuri aSliloba

307.23 Jil de la turetis daavadeba _ mravlobiTi motoruli da vokaluri tikebi;

307.22 qronikuli motoruli da vokaluri tikuri aSliloba _ an motoruli, an vokaluri tikebi;

307.21 gardamavali tikuri aSliloba _ zemoaRniSnuli ti-kebi, magram ara umetes �� Tvis xangrZlivobiT;

307.20 sxva tikuri aSliloba.

gamoyofis aSliloba

787.6 enkoprezi _ uneblie defekacia SekrulobiT;

307.7 Sekrulobis gareSe

307.6 enurezi _ uneblie Sardva.

Cvilobis, bavSvobisa da ymawvilobis sxva aSliloba

309.21 daSorebiT gamowveuli SfoTviTi aSliloba;

313.23 eleqtiuri mutizmi _ erT an ramdenime socialur si-tuaciaSi urTierTobisaTvis enis gamoyenebis akrZalva;

313.89 mijaWvulobis reaqtiuli darRveva Cvilobis da adreu-li bavSvobis asakSi _ sxvebTan urTierTobis mniSvnelo-vani gaZneleba 5 wlamde, rac ar aris dakavSirebuli sxva klinikur mdgomareobebTan;

307.3 stereotipuli moZraobebis aSliloba;

313.9 Cvilobis, bavSvobisa da ymawvilobis sxva, dauzustebe-li aSliloba

ICD-10 daavadebaTa saerTaSoriso saklasifikacio sis-temaa, romelic aseve kategorialuria da mravalganzomi-lebiani. sxvadasxva daavadebebisa da mdgomareobebis simp-tomebi da ganmasxvavebeli kriteriumebi 6 ganzomilebazea aRwerili.

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I ganzomileba – klinikuri fsiqopaTologiuri sindrome-bi. am ganzomilebaze moTavsebulia fsiqiuri da qceviTi aSlilobebi garda fsiqikuri ganviTarebis specifikuri darRvevebisa, romlebic II ganzomilebazea warmodgeni-li da gonebrivi CamorCenilobisa, romelic III ganzomi-lebazea moTavsebuli. bavSvobisa da mozardobis ganvi-Tarebis, qceviTi da emociuri aSlilobebis klinikuri sindromebic am ganzomilebazea warmodgenili.

II ganzomileba _ fsiqikuri ganviTarebis specifikuri darR-vevebi. am ganzomilebaze warmodgenili mdgomareobebis kodireba aRweriTi xasiaTisaa. fsiqikur ganviTarebaSi specifikuri Seferxebebis diagnostireba da kodireba maTi etiologiisgan damoukideblad xdeba am ganzomi-lebaze. gamonakliss warmoadgens pedagogiuri miSvebu-loba da arasrulfasovani swavleba.

III ganzomileba _ inteleqtis done. am ganzomilebaze aRiwe-reba individis aqtualuri inteleqtualuri funqcioni-rebis done. am SemTxvevaSic, kodireba aRniSnul ganzo-milebaze xdeba miuxedavad etiologiuri faqtorisa da prognozisa. kerZod, miuxedavad socialur-kulturuli deprivaciisa, socialur-ekonomikuri siduxWirisa, daa-vadebisa (mag. daunis sindromi), gonebrivi CamorCenilo-bis diagnostireba III ganzomilebaze xdeba da aRweriTi xasiaTisaa. ganmsazRvreli faqtorebisa da prognozis kodireba ki damatebiT IV, V, da VI ganzomilebaze xdeba.

IV ganzomileba _ somaturi mdgomareoba. am ganzomileba-ze klasificirdeba somaturi da nervuli sneulebebi da mocemulia maTi sindromebis sadiagnostiko kriteriu-mebi.

V ganzomileba _ Tanmxlebi anomaluri fsiqosocialuri situaciebi. am ganzomilebaze aRwerilia anomaluri fsiqosocialuri situaciebi, romelTac SesaZloa gav-lena moaxdinon fsiqiuri aSlilobis aRmocenebaze an SeiZleba didi mniSvneloba hqondes mkurnalobisa da daxmarebis dagegmvisas.

VI ganzomileba _ fsiqosocialuri produqtulobis darRve-

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vis zogadi Sefaseba. am ganzomilebaze aRiwereba indivi-dis fsiqikuri, socialuri da SromiTi funqcionirebis xarisxi, romelic SeiZleba gamowveuli iyos fsiqiuri aSlilobiT, fsiqikuri ganviTarebis specifikuri darR-veviT da gonebrivi CamorCenilobiT.

Cvilobis, bavSvobisa da mozardobis asakis ZiriTadi darRvevebi ICD-10-is mixedviT:

I ganzomileba: klinikuri fsiqopaTologiuri sindromebi

F84 ganviTarebis zogadi darRvevebi

F84.0 bavSvTa autizmi F84.1 atipuri autizmi

F84.2 retis sindromi

F84.3 bavSvTa asakis sxva dezintegraciuli aSlilobebi

F84.4 hiperaqtiuri darRveva gonebriv CamorCenilobasa da streotipul moZraobebTan erTad

F84.5 aspergeris sindromi

F84.8 ganviTarebis sxva zogadi darRvevebi

F84.9 ganviTarebis zogadi darRvevebi,dauzustebeli

F90-F98 qceviTi da emociuri aSlilobebi, romlebic bavSvo-bisa da mozardobis asakSi iwyeba:

F90 hiperkinetikuri aSliloba

F90.0 aqtivobisa da yuradRebis darRveva

F90.1 qcevis hiperkinetikuri aSliloba

F90.8 sxva hiperkinetikuri aSliloba

F90.9 dauzustebeli hiperkinetikuri aSliloba

F91 qceviTi aSliloba

F91.0 qceviTi aSliloba mxolod ojaxur garemoSi

F91.1 arasocializebuli qceviTi aSliloba

F91.2 socializebuli qceviTi aSliloba

F91.3 opoziciuri-gamomwvevi qceviTi aSliloba

F91.8 sxva qceviTi aSliloba

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F91.9 dauzustebeli qceviTi aSliloba F92 Sereuli qceviTi da emociuri aSliloba

F92.0 depresiuli qceviTi aSliloba

F92.8 sxva Sereuli qceviTi da emociuri aSliloba

F92.9 dauzustebeli Sereuli qceviTi da emociuri aSliloba

F93 bavSvobis asakis emociuri aSliloba

F93.0 bavSvTa asakis SfoTviTi aSliloba, dakavSirebuli ganSorebis SiSTan

F93.1 bavSvTa asakis SfoTviT-fobiuri aSliloba

F93.2 bavSvTa asakis socialuri SfoTviTi aSliloba

F93.3 da-ZmasTan konkurenciis aSliloba

F93.8 bavSvTa asakis sxva emociuri aSliloba

F93.9 bavSvTa asakis dauzustebeli emociuri aSliloba

F94 socialuri funqcionirebis darRveva, romelic bavSvo-bis asakSi iwyeba

F94.0 eleqtiuri mutizmi

F94.1 bavSvTa asakis mijaWvulobis reaqtiuli aSliloba

94.8 bavSvTa asakis sxva socialuri funqcionirebis darRveva

94.9 dauzustebeli bavSvTa asakis socialuri funqcionire-bis darRveva

F95 tikuri aSliloba

F95.0 tranzitoruli tikuri aSliloba

F95.1 qronikuli motoruli da vokaluri tikuri aSliloba

F95.2 de la turetis sindromi

F95.8 tikuri sxva aSlilobebi

F95.9 dauzustebeli tikuri aSliloba

F98 qceviTi da emociuri sxva aSlilobebi bavSvobisa da mozardobis asakSi dasawyisiT

F98.0 araorganuli warmoSobis enurezi

F98.00 pirveladi enurezi, dauzustebeli

F98.01 pirveladi Ramis enurezi

F98.02 pirveladi dRis (da Ramis) enurezi

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F98.03 meoradi enurezi, dauzustebeli

F98.04 meoradi Ramis enurezi

F98.05 meoradi dRis (da Ramis) enurezi

F98.1 araorganuli warmoSobis enkoprezi

F98.2 bavSvobisa da mozardobis kvebis aSliloba

F98.3 bavSvobisa da mozardobis arasakvebi nivTierebebis miRebis aSliloba (pika)

F98.4 stereotipuli moZraobis aSliloba

F98.5 enaborZikoba

F98.6 uwesrigo metyveleba

F98.8 bavSvobisa da mozardobis sxva dazutebuli qceviTi da emociuri aSlilobebi (masturbacia, frCxilebis kvneta, cxvirSi TiTiT CiCqna; TiTis wova).

F98.9 bavSvobisa da mozardobis dauzustebeli qceviTi da emociuri aSlilobebi

II ganzomileba: fsiqikuri ganviTarebis specifikuri darRvevebi

XX fsiqikuri aSlilobis gareSe

F80 metyvelebis ganviTarebis specifikuri darRvevebi

DSM -is da ICD-is dadebiTi mxareebi:

• kompleqsuroba _ aRwerilia mdgomareobaTa farTo speqtri, romlebic detaluradaa diferencirebuli da gaerTianebulia kategoriebSi;

• saerTo leqsikoni _ klasifikacia uzrunvelyofs stan-dartul leqsikons, romlis saSualebiTac xdeba bavSvTa mdgomareobis identifikacia;

• sandooba _ sxvadasxva mdgomareobis erTmaneTisagan gar-Ceva maRali sandoobis doniTaa SesaZlebeli;

• kros-kulturuli gamoyenebis SesaZlebloba _ SesaZle-belia sxvadasxva qveynis klinicistebis monacemebisa da dakvirvebebis erTmaneTTan Sedareba.

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DSM-IV-is ICD-10-is uaryofiTi mxareebi:• orive sistema kategorialuria. kategorialuri tipis

klasifikacia zusti da sandoa maSin, rodesac sadiag-nostiko klasi homogenuria, klasebs Soris mkafio saz-Rvrebia da sxvadasxva klasi gamoricxavs erTmaneTs. DSM-IV- sa da ICD-10 –Si fsiqikuri aSlilobebis kate-goriebi ar aris diskretuli, ara aqvs mkafio sazRvrebi da sxvadasxva kategoriis wevrebi mkveTrad SeiZleba ar gamoricxavdnen erTmaneTs. aseve, erTi diagnostikuri kategoriis wevrebi heterogenuli jgufia; miuxedavad msgavsi diagnostikuri niSnebisa, masSi Semavali indi-videbi gansxvavdebian da maTi diagnostireba garkveuli xarisxis albaTobiT xdeba;

• rodesac mdgomareoba aSkara da garkveulia (mag. yur-adRebis deficitisa da hiperaqtivobis sindromis dros), sandooba maRalia, magram, Tu mdgomareoba naklebad aSkaraa ( mag. yuradRebis deficiti hiperaqtivobis gar-eSe), sandoobis xarisxi bevrad mcirdeba. igive SeiZleba iTqvas sxva mdgomareobebis, mag. daswavlis unaris dar-Rvevebis Sesaxebac;

• bavSvobisa da ymawvilobis asakis diagnozebSi droSi stabilurobis Sesaxeb informacia TiTqmis ar aris;

• diagnostikur sistemebs mdgomareobis diagnostikur kategoriaSi, mdgomareobis paTologizaciaSi moqce-vis uxeSi tendencia aqvs. bavSvebis umetesobas Sereu-li mdgomareobebi aqvs da saxelmZRvaneloSi aRwerili klasterebi sufTa saxiT maT mcire nawils uvlindeba; Sereuli mdgomareobebis gamo diagnozi sxvadasxva di-agnostikur kategoriebs Soris Tavsdeba. klinicistebi-sTvis kargadaa cnobili, rom kategorialuri Sefasebebi zusti ar aris;

• diagnozebi, nawilobriv, sqematur xasiaTs atarebs. aq-centi ZiriTad `klinikur sindromze~ keTdeba da, miuxe-davad sxva ganzomilebebis arsebobisa, ar xdeba bavSvis yovelmxrivi Sefaseba;

• diagnozi naklebad iTvaliswinebs ganviTarebis perspeq-tivas, kulturul da socialur gansxvavebebs. (A.Carr,

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�997; Harris, 1995). am problemis dasaZlevad DSM-IV-TR-Si nacadia kulturuli da eTnikuri gansxvavebebis gaT-valiswineba diagnostirebisas. specialur damatebaSi mocemulia specifikuri sindromebi, damaxasiaTebeli gansxvavebuli kulturebisTvis, aseve gavrcelebuli sindromebis SesaZlo kulturuli variaciebi.

multivariaciuli midgoma

es midgoma, mdgomareobebis ZiriTadi klasterebisa da maTTvis damaxasiaTebeli ZiriTadi niSnebis identifika-ciis mizniT iyenebs statistikur analizs. igi mTlianad efuZneba statistikur proceduras da naklebad eyrdnoba profesiul eqspertul mosazrebas. aRniSnulma midgomam bavSvTa darRvevebis ori farTo ganzomileba mogvca (klas-terebis jgufebi). pirveli moicavs `qceviT~ problemebs da ganisazRvreba rogorc `eqsternalizebuli~, dakavSirebu-lia agresiasTan da mis gamovlinebebTan: mag. Cxubi, urCoba, banditur dajgufebaSi gaerTianeba. meore ganzomilebiT pirovnebis problemebi ganisazRvreba rogorc “internali-zebuli”, romelic dakavSirebulia SfoTvasTan, Caketi-lobasTan da vlindeba mag. tirilSi, wuxilSi, sevdasa da depresiaSi. es midgoma Camoyalibda Achenbach, Hewith-is, Jenkins-is, Quay-sa da Werry-is kvlevebis safuZvelze (Cul-linan, 1983). maT gamoyves mdgomareobaTa klasterebi. mdgo-mareoba aRwerilia yoveli klasteris farglebSi da eTanx-meba empiriul monacemebsa da dakvirvebebs:

1. arasocializebuli agresiuli qceviTi aSliloba: Cxubobs, urtyams, scems, Zaladobs, aSinebs, dascinis, urCevnia umcrosebTan urTierToba, gamomwvevia, urCi, Tavxedi, gaufrTxilebeli, aqvs sibrazisa da sijiutis Setevebi, gulgrilia, xmauriani, negatiuri, mousvenari, ityueba, arakeTilsindisieria, Wirveuli, zedmetad aqtiuri.

2. socializebuli agresiuli qceviTi aSliloba: acdens sko-las, saxlidan garbis, iparavs sxvebTan erTad, iparavs saxl-idan, TaRliTobs, ityueba, erTiandeba banditur dajgufe-baSi, SeniSnulia samarTaldamcavi organoebis mier.

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3. yuradRebis deficiti: yuradRebis mwiri koncentracia, yuradRebis mcire moculoba, cudi koordinacia, meoc-nebe, mouxerxebeli, pasiuri, uiniciativo, mousvenari, cqmutavs, swrafad gadaerTveba, ar amTavrebs saqmes, impulsuria, advilad wyindeba, hiperaqtiuria, inertu-lia.

4. SfoTva, ganmartoeba (Caketva): daZabulia, morcxvi, depresiuli, gamoirCeva Zlieri SfoTviT, mSiSaraa, sev-diani, gaubedavi, mgrZnobiare, wuxs, xSirad tiris, nak-lebad TviTdarwmunebulia, advilad ucruvdeba imedi, aqvs umaqnisobisa da uvargisobis gancda.

5. `Sizoidi~ (gulcivi): Caketilia, civi, aragulisxmieri, gaubedavi, sevdiani, morcxvi, gulCaTxrobili, areuli, daxuruli, ar saubrobs, aqvs interesis nakleboba.

6. socialuri Seusabamoba: mwiri urTierToba aqvs Tana-tolebTan, ganmartoebulia, morcxvi, gaubedavi, ig-norirebulia tolebis mier, urTierTobs ufrosebTan.

7. fsiqoturi aSliloba: abneulia, ucnauri, aqvs ganmeo-rebadi metyveleba, mxedvelobiTi an smeniTi halucina-ciebi, ucnauri ideebi da qcevebi.

8. motoruli zeaqtiuroba: mousvenaria, impulsuri, hiper-aqtiuri, agznebuli, ar SeuZlia dacda, bevrs lapara-kobs, ucnaur xmebs uSvebs.

multivariaciuli midgomis dadebiTi mxareebi:

• es midgoma aRwers im mdgomareobebs, romlebic identi-ficirebulia klinicistebis mier, e.i. eyrdnoba realur gamovlinebebs da ara hipoTetur konstruqtebs;

• is ranJirebis instrumentia, romlis saSualebiTac izomeba bavSvis normidan gadaxra;

• is iZleva darRvevis sxvadasxva konteqstSi ganxilvis sa-Sualebas.

multivariaciuli midgomis uaryofiTi mxareebi:

• vinaidan es midgoma aRweriT kvlevebs eyrdnoba, dgeba maTi sandoobisa da validobis problema;

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• aRniSnuli skalebiT individis mTliani mdgomareobis gansazRvra Znelia, mag. c.n.s.-is dazianebis mqone, das-wavlis unaris daqveiTebis Tu disleqsiis mqone bavSvis identificireba SeuZlebelia;

• darRveuli qceva damokidebulia im specifikur piro-bebze, romelSic xdeba misi gansazRvra. miuxedavad msgav-sebisa, erT situaciaSi miRebuli monacemi, SeiZleba, araTavsebadi iyos sxva situaciaSi miRebul monacemTan.

Tu erTmaneTs SevadarebT multivariaciul da kate-gorialur midgomebs, davinaxavT, rom eqsternalizebu-li da internalizebuli ganzomilebebi Achenbach-is Child Behavioral Cheklist-Si eTanxmeba ICD-isa da DSM-is diag-nozebs. amave dros, is bavSvebi, romlebic am ganzomilebaTa kideebSi xvdebian, DSM da ICD kategorialuri sistemebiT ver klasificirdebian. eqsternaluri da internaluri ma-xasiaTeblebi populaciaSi normalurad nawildeba, amitom bavSvTa umravlesobas problemebi orive ganzomilebaSi aqvs. multivariaciuli midgomebiT iolia xSiri, gavrcele-buli sindromebis identifikacia, magram Znelad xerxdeba SedarebiT iSviaTi sindromebis gansazRvra; es ukanasknelni ukeTesad ganisazRvreba kategorialuri sistemiT (mag. ro-goricaa autizmi, an enkoprezi). kategorialuri sistemebi, romelTa ricxvsac miekuTvneba DSM da ICD, sasargebloa iseTi sindromebis diagnostirebisaTvis, rogoricaa ganvi-Tarebis pervesiuli aSlilobebi, tikebi da erTeuli simp-tomebis gamovlineba _ pika, Ramis panikuri SiSebi.

klinikur praqtikaSi, bavSvis statusis dasadgenad, qce-visa da swavlis problemebis mravalganzomilebiani Sefa-seba aucilebelia. sando da validuri monacemebis miRebis mizniT warmatebiT iyeneben qcevis Sesafasebel kiTxvarebs, unarebis Tu ganviTarebis Sesafasebel testebs, neirof-siqologiur testirebas.

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empiriuli midgoma

es midgoma multivariaciuli midgomis variantia da Edelbrock-is, Achenbach-isa da McConaughy-is saxelebs ukav-Sirdeba. igi eyrdnoba Semdeg fsiqometrul principebs:

• Sefaseba unda eyrdnobodes standartul proceduras;

• bavSvis yoveli aspeqtis Sesafaseblad gamoyenebuli unda iyos informaciis mravali wyaro;

• testirebis Sedegebi raodenobriv monacemebs unda iZ-leodes;

• qulebi unda gviCvenebdes mocemuli individis adgils mis Sesabamis asakobriv jgufSi;

• gaTvaliswinebul unda iqnes ganviTarebis faqtorebi;

• Sefaseba unda iyos validuri da sando.

aRniSnuli kriteriumebi, zogadad, Sefasebis yvela sis-temisTvisaa mowodebuli. es mravalganzomilebiani midgoma 5 ganzomilebas moicavs: � _ mSoblebi, � _ maswavleblebi, 3 _ kognituri Sefaseba, 4 _ fizikuri Sefaseba, 5 _ bavSvis pirdapiri Sefaseba.

samive saklasifikacio sistemas gaaCnia susti da Zlie-ri mxareebi. bavSvebs xSirad aqvT kompleqsuri problemebi, ris gamoc ver xerxdeba verc multivariaciuli da verc kategorialuri Sefasebis gamoyeneba. DSM da ICD klasifi-kacia SeiZleba, mosaxerxebeli iyos kvlevisa da klinikuri praqtikisaTvis, magram maT ar gaaCniaT iseTi sandooba da validoba, romelic maTi sayovelTaod gamoyenebis garanti iqneboda. aRniSnuli sistemebi pirovnebis stigmatizacias uwyobs xels; isini, SeiZleba, gamoyenebul iqnas mxolod Se-sabamisad momzadebuli fsiqiatrebisa da klinikuri fsiqo-logebis mier.

aqedan gamomdinare:• orive midgoma _ kategorialuri da multivariaciuli -

gamoiyeneba bavSvis qcevisa da ganviTarebis Sefasebisas;

• kategorialuri midgomebi ufro sando da efeqturia kv-leviTi miznebisaTvis;

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• multivariaciuli midgomebi ufro efeqturia bavSvis sirTuleebis Tavis askobriv jgufTan mimarTebaSi gan-sasazRvrad.

eTikuri TvalsazrisiT gasaTvaliswinebelia, rom dia-gnozi iwvevs bavSvebis paTologizacias. diagnozSi yura-dReba maxvildeba uaryofiT mxareebze, darRvevebze da ar moicavs bavSvis dadebiT, Zlier mxareebs. tradiciuli dia-gnostikis procesi bavSvSi iwvevs defeqturobis aRqmas da stigmatizacias, radganac ZiriTadi aqcenti mis paTologia-sa da deficitze keTdeba. diagnozi unda moergos mxolod mdgomareobis aRweras, Sesabamis mkurnalobas, an stra-tegiis dagegmvas. igi ar unda warmoadgendes bavSvisa da misi ojaxisaTvis `iarliyis miwebebis~ sababs. mdgomareoba maqsimalurad frTxilad unda ganisazRvros da moicavdes ara mxolod bavSvis deficitis aRweras, aramed mis Zlier mxareebsa da SesaZleblobebsac.

fsiqikuri aSlilobebis diagnostikuri saxelmZRvane-loebis gamoyeneba diagnostirebisaTvis SesaZlebelia mxo-lod gavarjiSebuli da klinikurad gamocdili speciali-stebisaTvis. DSM-IV-sa da ICD-10-s gamoyeneba dauSvebelia meqanikurad araprofesionalebis mier. es sistemebi SeiZle-ba ganvixiloT rogorc saxelmZRvanelo (gaidlaini) kli-nikuri daskvnebis gasakeTeblad da konkretuli fsiqikuri mdgomareobis interpretaciisaTvis.

ganviTarebis darRvevebis klasifikacia

ganviTarebis darRvevebis, kerZod ki autizmisa da gone-brivi CamorCenilobisadmi aqtiur interess didi xnis isto-ria aqvs. miuxedavad imisa, rom termini `daswavlis unaris daqveiTeba~ mxolod �960-ian wlebSi iqna SemoRebuli, li-teraturaSi swavlis specifikuri profilis mqone bavSvebi ukve �800-iani wlebidanaa aRwerili; ukve �700-iani wlebi-dan gvxvdeba gonebrivi CamorCenilobis suliT avadmyofe-bisagan gansxvavebis mcdeloba; aseve, mravali mcdeloba ar-sebobda ganviTarebis darRvevebis sxvadasxva fsiqiatriul

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nomenklaturaSi CarTvisa da pirveladi fsiqikuri aSlilo-bebisgan maT gamosacalkeveblad. dReisaTvis, DSM-Si, gan-viTarebis darRvevebi I ganzomilebazea moTavsebuli.

Achenbach-i (1985) aRniSnavda, rom klasifikacia gu-lisxmobs dakvirvebadi mdgomareobebis jgufebad da tipe-bad sistemur mowesrigebas. igi ganasxvavebs zogad klasi-fikacias da taqsonomias. es ukanaskneli sxvadasxva klasebs Soris Sinagani gansxvavebebis asaxvas niSnavs. cxadia, rom es Sinagani gansxvavebebi ganisazRvreba sxvadasxva raodeno-bis parametrebiTa da maTi kombinaciiT. aseT parametrebs miekuTvneba etiologia, specifikuri qcevebi, fizikuri ma-xasiaTeblebi.

miuxedavad mravali xarvezisa, klasifikaciis sistemas bevri dadebiTi mxare aqvs. Blashfield-i (1984) Tvlida, rom klasifikaciis adekvaturi sistema uzrunvelyofs rele-vantur informacias, romelic moicavs simptomebis saxesa da raodenobas, prognozs, mkurnalobas, mkurnalobis Sede-gebs, komorbidul mdgomareobebs, etiologiur varaudebs. sxvadasxva mkvlevrebi klasifikaciis sistemisTvis Semdegi maxasiaTeblebis aucileblobas aRniSnaven: • unda iyos martivi;• unda eyrdnobodes farTo gamoyenebis gansazRvrebebs

da farTo speqtris cvladebs;• asaxavdes mocemul sferoSi upiratesad gavrcelebul

klinikur da Teoriul Sexedulebebs; • misi gamoyeneba unda iyos advili.

amave dros, zogierTi mkvlevari eWvs gamoTqvamda kla-sifikaciis sistemis gamoyenebis sargeblianobasTan dakav-SirebiT. Huschka (1941) icavda ideografiul midgomas da Tvlida, rom klasifikaciis sistemaSi individuri gansxvave-bebis ignorireba xdeba, ris gamoc brkoldeba ganviTarebis darRvevebis gageba. Szasz-i (1978) Tvlida rom diagnozi pi-rovnebis mniSvnelovan socialur stigmatizacias iwvevs.

amrigad, klasifikaciis dadebiTi da uaryofiTi mxare-ebis gaTvaliswineba metad mniSvnelovani da aucilebelia. klasifikaciis sistema unda akmayofilebdes sandoobis, va-lidobisa da klinikuri vargisianobis kriteriumebs. Can-twell-ma (1988) aRniSna, rom sandoobisa da validobis saki-

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Txebi upirvelesi mniSvnelobisaa nebismieri klasifikaciis sistemisaTvis. klasifikaciisas gasaTvaliswinebelia:• gamoyenebuli gansazRvrebebis sizuste;

• Sesaswavli SerCeviTi erTobliobis buneba;

• ramdenadaa gaTvaliswinebuli SerCeviTi erTobliobis cvladebi _ sqesi, asaki, socialur-ekonomikuri statusi da a.S.;

• ganviTarebis kanonzomiereba.

saklasifikacio modelebi

ganviTarebis darRvevebis mqone bavSvebis klasifikacia or ZiriTad midgomas eyrdnoba:

�. klinikuri daskvnis midgomis safuZvels warmoadgens sferos specialistebis klinikuri dakvirvebebi da das-kvnebi; bavSvTa fsiqopaTologiis klasifikaciaSi swored aRniSnuli midgoma dominirebs da masve efuZneba DSM da ICD. aRniSnuli midgoma naklebad sistematizebulia; klasi-fikaciuri sqema hipoTezebis wamoyenebas gulisxmobs, maTi Semowmeba ki pirdapiri gziT ver xerxdeba. klinikuri das-kvnis midgomis nakli misi meTodologiuri sisuste, dabali validoba da sandoobaa. midgomis saklasifikacio sqemebis klinikuri vargisianoba sakmaod SezRudulia, radgan ganvi-Tarebis fsiqopaTologia ara romelime, aramed mraval ur-TierTmoqmed cvladTanaa dakavSirebuli.

2. empiriuli klasifikaciis teqnika. es midgoma efuZ-neba qcevis raodenobriv maxasiaTeblebs da, `sul an araf-ris~ kategoriebis sawinaaRmdegod, fsiqopaTologiis `pro-totipuli~ profilebis Seqmnas cdilobs. aRniSnuli sak-lasifikacio sistemis gamoyenebam gamoavlina ganviTarebis specifikuri darRvevebis heterogenuloba. klinikuri das-kvnis midgomasTan SedarebiT misi upiratresobis miuxeda-vad, empiriul midgomasac gaaCnia nakli. multivariaciuli klasifikaciis teqnikis simartive Zalze mimzidvelia, ris gamoc mkvlevrebs `gulubryvilo empirizmisaken~ ubiZgebs. empiriuli klasifikaciis meTodze dafuZnebuli modelis

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adekvaturoba da siZliere damokidebulia Teoriul orien-taciaze, populaciisa da cvladebis SerCevaze. mag. Tu po-pulaciis SerCeviTi erToblioba kargad ar aris gansazRv-ruli, naklebad kontroldeba damoukidebeli cvladebi, xolo damokidebuli cvladebi Teoriuli safuZvlis mixed-viT araa SerCeuli, maSin empiriuli analizis safuZvelze miRebuli ganzomilebebi da jgufebi sxva populaciaSi, an sxva situaciaSi gamosayeneblad ar gamodgeba.

v. lebedinskis klasifikaciaes klasifikacia efuZneba fsiqikuri ganviTarebis kanon-

zomierebis darRvevis maxasiaTeblebs. kerZod, aRniSnuli klasifikaciis saSualebiT xdeba ganviTarebis anomaliis tipis diferencireba ara nozologiuri principiT, aramed darRvevis etio-paTogenezisa da fsiqologiuri struqtu-ris safuZvelze. v. lebedinski gamoyofs fsiqikuri dizon-togenezis Semdeg variantebs: ganuviTarebloba, Seferxe-buli ganviTareba, dazianebuli ganviTareba, deficituri ganviTareba, damaxinjebuli ganviTareba, disharmoniuli ganviTareba.• ganuviTareblobis tipis dizontogenezisaTvis damaxa-

siaTebelia dazianebis adreuli _ pre- an postnataluri periodi, rac ganapirobebs Tavis tvinis sistemebis to-talur Camouyalibeblobas. ganviTarebis am tipis darR-vevas axasiaTebs, erTis mxriv, elementaruli fsiqikuri funqciebis garkveuli xarisxiT Camoyalibeba, meores mxriv, umaRlesi, simboluri funqciebis ganviTarebis darRvevis gamo saTanadod veRar viTardeba elementa-ruli fsiqikuri funqciebic (metyvelebis da azrovnebis ganviTarebis darRveva iwvevs asakis Sesabamisi ganviTa-rebis deficits aRqmasa da motorikiaSi). ganuviTareb-loba ori ZiriTadi niSniT xasiaTdeba: nervul-fsiqi-kuri ganuviTareblobis totalurobiT da fsiqikuri defeqtis ierarqiulobiT. totaluroba gulisxmobs moumwifebel somatur funqciebsa da Camouyalibebel metyvelebas, mexsierebas, azrovnebas, sensomotorul da pirovnul-emociur sferoebs. ierarqiulobis qveS igulisxmeba SedarebiT Camoyalibebuli elementaruli

4�

fsiqikuri funqciebis fonze metyvelebisa da azrovne-bis ganviTarebis darRveva da inteleqtualuri funq-ciebis gansakuTrebuli moSla. amasTan, es orive niSani Seuqcevadia.

ganuviTareblobis tipur models gonebrivi Camor-Ceniloba warmoadgens.

• Seferxebis tipis dizontogenezisaTvis damaxasiaTebe-lia SemecnebiTi da emociuri sferos ganviTarebis Se-neleba, funqciaTa ganviTarebis ciklis droSi gawelva. ganviTarebis Seferxeba SeiZleba gamowveuli iyos gene-tikuri, fsiqogenuri, rezidualuri xasiaTis cerebrul-organuli faqtorebiT.

ganviTarebis SeferxebisaTvis damaxasiaTebelia ori niSani: dazianebis mozaikuroba _ zogierTi fsiqikuri funqciis ganviTareba deficituria, xolo zogierTi funqcia ki Senaxulia. ZiriTadad, Senelebulia ele-mentaruli, bazisuri unarebis momzadeba (mag. natifi motorika, fonologiuri analizi, vizualur-sivrciTi garCeva).

Seferxebis tips SeiZleba gansazRvravdes Semdegi saxis darRvevebi: �. fsiqikuri funqciebis dinamiku-ri parametrebis deficiti (aqtivaciis done, nervuli procesebis agzneba-Sekavebis moqniloba, mdgradoba); �. fsiqikuri funqciebis parcialuri deficiti (metyvele-bis, gnozisis, praqsisis); 3. aRmasrulebeli funqciebis deficiti, romlebic uzrunvelyofs moqmedebis dawye-bas, dagegmvas, kontrols, gadarTvas.

Seferxebis tipur models miekuTvneba da swavlis unaris darRveva, disleqsia.

• deficituri ganviTareba dakavSirebulia analizatoru-li sistemebis _ smenis, mxedvelobis, mamoZravebeli sis-temis pirvelad darRvevebTan. analizatoris pirveladi defeqti iwvevs im funqciebis ganviTarebis darRvevas, romlebic masTan uSualodaa dakavSirebuli da amave dros, aferxebs im funqciebis ganviTarebasac, romlebic am darRveul funqciasTan aris dakavSirebuli. defici-turi ganviTarebis tipuri modelia cerebruli dambla, sibrmave, smenis daqveiTeba.

4�

• dazianebuli ganviTarebis paTogenezis dros centralur nervul sistemaze mavne zemoqmedeba xdeba sicocxlis ufro gviandel periodSi (�-3 weli), rodesac Tavis tvi-nis sistemebis umetesoba ukve Camoyalibebulia. dizon-togenezis am tipis modelia demencia, rodesac xdeba funqciaTa Soris rTuli ierarqiuli kavSirebis rRveva, inteleqtisa da qcevis Seuqcevadi regresi.

• damaxinjebul ganviTarebas erTdroulad axasiaTebs ga-nuviTareblobis, calkeuli funqciebis Seferxebuli da aqselerirebuli ganviTarebis niSnebi. aseTi tipis di-zontogenezis modelia pervesiuli aSliloba, kerZod, autizmi.

• disharmoniuli ganviTarebisaTvis damaxasiaTebelia zo-gierTi funqciuri sistemis ganviTarebis Seferxeba da zogis parcialuri aqseleracia. darRvevis safuZvelia konstituciuri, memkvidreobiT miRebuli, an adre Se-Zenili emociur-nebelobiTi sferos ganviTarebis dis-proporciuli ganviTareba. aRniSnuli tipis dizonto-genezis modelia pirovnebis aSlilobebi da fsiqopaTia.

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gonebrivi CamorCeniloba

ra aris gonebrivi CamorCeniloba?

gonebrivi CamorCeniloba fsiqikuri ganviTarebis darR-vevis formaa. aRniSnuli mdgomareoba aRmocendeba adreul asakSi da mTeli cxovrebis manZilze axdens gavlenas adamia-nis fsiqikur ganviTarebasa da Cvevebis Camoyalibebaze.

amerikis gonebrivi CamorCenilobis asociaciis (AAMR) ganmartebis mixedviT: gonebrivi CamorCeniloba aris mniSv-nelovani gadaxra zogadi inteleqtualuri funqcionirebis donidan, romelic adaptaciuri qcevis deficits ukavSir-deba da vlindeba adamianis ganviTarebis periodSi. `zoga-di inteleqtualuri funqcionireba~, anu IQ – inteleqtis koeficienti _ aris inteleqtis individualurad Catare-bul testSi miRebuli qula. `mniSvnelovani gadaxra~ niSna-vs iseT IQ maCvenebels, romelic normaze sagrZnoblad da-balia. normaluri IQ _ 90-��0-is farglebSia, 80-89 _ normis qveda zRvaria, 70-79 _ mosazRvre mdgomareobaa. CamorCeni-lobis Sesaxeb msjeloba SesaZlebelia maSin, rodesac IQ _ 70-ze dabalia.

`adaptaciuri qcevis deficiti~ niSnavs momwifebaSi mni-Svnelovan CamorCenas da swavlaSi, pirovnul damoukide-blobasa da socialur pasuxismgeblobaSi SezRudvebs. `gan-viTarebis periodSi~- dabadebidan �8 wlamde, Tumca uka-nasknel xans mucladyofnis periodidan �8 wlamde periods gulisxmoben.

gonebrivi CamorCeniloba xasiaTdeba inteleqtualuri unarebis daqveiTebiT da adaptaciuri unarebis (komunika-cia, TviTmomsaxureba, socialuri Cvevebi, swavla, muSaoba, dasveneba, saojaxo saqmianoba) or an met sferoSi darRve-viT.

ganmartebidan Cans, rom gonebrivi CamorCenilobis dia-gnozi damokidebulia rogorc pirovnebis inteleqtis, ise sxva igive asakisa da kulturis adamianebTan mimarTebaSi am pirovnebis socialuri unarebisa da damoukideblad fun-qcionirebis Sefasebaze.

gonebrivi CamorCeniloba sxvadasxva xarisxisaa. igi da-

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mokidebulia ganviTarebis darRvevis xarisxze, rac vlinde-ba SemecnebiTi, emociuri da nebelobiTi sferos ganviTare-bis donis asakobriv normasTan SedarebiT. Zveli klasifika-ciiT gonebrivi CamorCenilobis xarisxs gansazRvravdnen IQ testSi miRebuli qulebis mixedviT:

50-55 – 70 qula ioli gonebrivi CamorCeniloba;35-40 – 50 qula saSualo gonebrivi CamorCeniloba;�0-�5 – 40 qula Zlieri gonebrivi CamorCeniloba;<�0-ze qula mZime gonebrivi CamorCeniloba.�99� wlidan gonebrivi CamorCenilobis klasifikacia

xorcieldeba individis SesaZleblobebis, misi Zlieri da susti mxareebis, misi garemosTan Seguebis xarisxis mixe-dviT. Sesabamisad, gonebrivi CamorCenilobis xarisxi gani-sazRvreba imis mixedviT, Tu ra donis da xarisxis daxmareba esaWiroeba pirovnebas, anu ramdenad damoukidebelia igi.

gamoyofen daxmarebis 4 dones:

�. droebiTi: ar esaWiroeba mudmivi daxmareba, magram Sei-Zleba dasWirdes droebiTi mxardaWera garkveul SemTx-vevebSi, mag. profesiis aTviseba, samuSaos Sovna.

�. SezRuduli: periodulad esaWiroeba garkveuli saxis daxmareba, mag. finansebis gankargvasa da ganawilebaSi, profesiis aTvisebasa da Cvevebis gavarjiSebaSi.

3. eqstensiuri: esaWiroeba yoveldRiuri daxmareba cxovrebis sxvadsxva aspeqtSi.

4. yovlismomcveli: moiTxovs mudmiv, intensiur daxmare-bas cxovrebis yvela aspeqtSi.

gonebrivi CamorCenilobis gansazRvreba da diagnos-tikuri kriteriumebi Camoyalibebulia diagnostikuri da statistikuri saxelmZRvanelos me-4, gadasinjul gamocemaSi (DSM-4), daavadebaTa saerTaSoriso klasifikaciis me-�0 gamocemaSi (ICD-10) da amerikis gonebrivi CamorCenilobis asociaciis saxelmZRvaneloSi (AAMR).

DSM-4-is da AAMR-is gonebrivi CamorCenilobis gan-sazRvreba ufro funqcionaluri xasiaTisaa, vidre samedi-cino, an fsiqopaTologiuri. igi moicavs funqciur Sez-Rudvebs (inteleqtis da adaptaciuri Cvevebis) specifikur

45

garemoSi (saxli, skola, sazogadoeba) da Sesabamisad, nor-maluri cxovrebisaTvis specialuri daxmarebis xarisxs. ICD-10 ganmarteba, tradiciulad, samedicino midgomas eyrdno-ba. AAMR-is mixedviT gonebrivad CamorCenili pirovnebis diagnostika da misi moTxovnilebebis gansazRvra xdeba 4 ganzomilebis mixedviT:I ganzomileba _ inteleqtualuri funqcionireba da adap-

taciuri Cvevebi;II ganzomileba _ fsiqologiuri da emociuri statusi;III ganzomileba _ fizikuri, janmrTelobis da etiologiuri

faqtorebi;IV ganzomileba _ garemos faqtorebi.

gonebrivi CamorCenilobis (gC) diagnostikuri kriteriumebi

DSM-IVsaSualoze mniSvnelovnad dabali gonebrivi funqcio-

nireba; individuri testirebis dros 70-ze dabali IQ.adaptaciuri funqcionirebis Tanmxlebi darRvevebi Sem-

degi ori an meti sferodan:

• komunikacia;

• Tavis movla;

• saxlis movla;

• socialuri interpersonaluri Cvevebi;

• sazogadoebrivi urTierTobis Cvevebi;

• TviTmarTva;

• akademiuri Cvevebi;

• SromiTi saqmianoba;

• dasveneba;

• janmrTeloba da usafrTxoeba.

dawyeba �8 wlamde kodirebulia, rogorc:

• ioli gC IQ 50-55-70; 317.• saSualo gC IQ 35-40-50-55; 318.0

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• Zlieri gC IQ �0-�5- 35-40; 318.1• mZime gC IQ �0-�5-ze qvemoT. 318.2319 dauzustebeli

ICD-10diagnozisaTvis aucilebelia inteleqtualuri fun-

qciebis daqveiTebuli done, rac iwvevs socialuri garemos moTxovnebisadmi adaptaciis darRvevas.

inteleqtis done unda Sefasdes klinikuri dakvirvebis, adaptaciuri qcevis skalebis da fsiqometruli testebis gamoyenebiT.kodireba:

• ioli gC IQ 50-69; F70• saSualo gC IQ 35-49; F71• Zlieri gC IQ �0-34; F72• mZime gC IQ �0-ze dabali. F73

F78 sxva

F79 dauzustebeli

AAMRgonebrivi CamorCeniloba iwvevs SezRudvebs adamianis yoveldRiur cxovrebaSi. igi xasiaTdeba:

• saSualoze mniSvnelovnad dabali inteleqtiT;

• Tanmxlebi SezRudvebiT adaptaciur CvevebSi Semdegi ori an meti sferodan:

komunikacia;

TviTmomsaxureba;

saxlis movla;

socialuri Cvevebi;

sazogadoebrivi urTierTobis Cvevebi;

TviTregulacia;

akademiuri funqcionaluri Cvevebi;

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janmrTeloba da usafrTxoeba;

SromiTi saqmianoba;

dasveneba.

gonebrivi CamorCeniloba vlindeba �8 wlamde

riT xasiaTdeba gonebrivi CamorCeniloba?gonebrivi CamorCenilobis dros bavSvis fsiqikuri gan-

viTarebis darRvevas farTo diapazoni aqvs. zogierT bavS-vSi es iolad vlindeba, zogierTs ki Zlierad aqvs gamoxat-uli. gonebrivi CamorCeniloba bavSvis fsiqikuri ganviTa-rebis Seuqcevad darRvevas gulisxmobs. es aseTi bavSvis ganaTlebisa da ganviTarebis SeuZlebelobas ki ar niSnavs, aramed gulisxmobs gonebrivi CamorCenilobis mqone bavS-vis ganviTarebis gansxvavebul kanonzomierebasa da temps. amitom, yoveli individualuri bavSvis swavlis SesaZle-blobebis dasadgenad, mniSvneloba aqvs misi ganviTarebis individualur temps da individualur SesaZleblobebs. gonebivi CamorCenilobis dasaxasiaTeblad aucilebelia gaviTvaliswinoT, rom bavSvis fsiqikuri ganviTareba Sem-deg sferoebs moicavs: SemecnebiTi unarebi, metyvelebisa da komunikaciis unari, msxvili da natifi motoruli un-arebi, socialur-emociuri ganviTareba.

• gonebrivi CamorCenilobis mqone pirebSi yvelaze gamoxatulad maTi azrovnebis specifikuri xasiaTi Cans. magaliTad, msgavsebis povna Tagvsa da spilos Soris: am amocanis gadaWra moiTxovs aRqmiT miRebuli TvalsaCino STabeWdilebebisa da asociaciuri gansxvavebebis ignori-rebas da msgavsebis povnas ori obieqtis iseTi Tvisebis mixedviT, romelic, erTi SexedviT, ar Cans. gonebrivi CamorCenilobis mqone bavSvebSi ZiriTadi problema mdgomareobs imaSi, rom ar SeuZliaT dominirebuli, TvalsaCino xatis safuZvelze aRmocenebuli azris uku-gdeba. gonebrivi CamorCenilobis mqone da armqone bavS-vebmac ician, rom Tagvica da spiloc cxovelia, magram, maT unda SeZlon zomaSi sxvaobis ignorireba. gonebrivi CamorCenilobis mqone bavSvis daskvnaze am gansxvavebis gavlena Zalian Zlieria. igi ver poulobs saerTo niSans,

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radgan mTeli misi yuradReba gansxvavebazea mipyrobili. am dros, bavSvis azrovneba konkretul-TvalsaCino xas-iaTs atarebs. bavSvis codnac konkretul-situaciuria da Znelia misi ganzogadeba sxva situaciaSi.

• gonebrivi CamorCenilobis mqone bavSvebs abstraqtul azrovnebasTan erTad sxva SemecnebiTi fsiqikuri fun-qciebis ganviTarebaSic aqvT sirTuleebi. kerZod:�. swavlis neli tempi: Cvevebis asaTviseblad, axali in-

formaciis SesaZenad bavSvs xangrZlivi periodi da xSiri gameoreba esaWiroeba.

�. yuradRebis darRveva: bavSvisaTvis didi problemaa nebiTi yuradRebis warmarTva da axal moqmedebaze misi gadanacvleba.

3. problemis gadawyvetis sirTuleebi: bavSvs uWirs da-moukideblad gaigos problemis xasiaTi da ipovos misi gadawyvetis gzebi. gadawyvetis daswavlis SemTxvevaSi ki uWirs SeZenili gamocdilebis sxva msgavs situacia-Si gamoyeneba.

• gonebrivi CamorCenilobis dros xSiria metyvelebis problemebi. metyvelebis ganviTarebis done damokide-bulia fsiqikuri ganviTarebis darRvevis xarisxze. rac ufro gamoxatulia gonebrivi CamorCeniloba, miT ufro meti problema aqvs bavSvs metyvelebis dauflebaSi. me-tyvelebis ganviTarebis sirTule metad mravalferova-nia, dawyebuli leqsikuri maragis, artikulaciis, sin-taqsis gamoyenebis, ambis moyolis problemebiT, dam-Tavrebuli metyvelebis ganviTarebis Zlieri darRveviT, rodesac bavSvs ar SeuZlia urTierTobis damyareba enis saSualebiT.

• gonebrivi CamorCenilobis dros bavSvs motoruli sfer-os problemebic aqvs: �. Cvilobis asakSi aseTi bavSvi gvian swavlobs dajdomas,

dgomas, siaruls.�. skolamdel asakSi misi moZraobebi mouqnelia, uWirs

SeTanxmebuli moZraobebis ganxorcieleba, mag. sirbi-li, burTiT TamaSi, kovzis, dana-Canglis xmareba.

3. uWirs natifi moZraobebis ganxorcieleba da Sesabam-

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isad, iseTi Cvevebis aTviseba, romelic xelebis da TiTebis natif, moqnil moZraobas moiTxovs: danis, makratlis, fanqris xmareba.

4. bavSvisaTvis rTulia nebiTi motoruli moqmedebis dagegmva da kontroli: iseTi moZraobebis Sesrule-ba, romlebic Tanmimdevrobas da SeTanxmebulo-bas moiTxovs. uWirs TviTmomsaxurebis Cvevebis da-moukideblad aTviseba (Wama, Cacma, tualeti, dabana). motoruli Cvevebis garkveuli xarisxiT aTviseba mxo-lod xangrZlivi varjiSis Semdeg xdeba SesaZlebeli.

• SemecnebiTi sirTuleebisa da komunikaciuri SezRud-vebis gamo bavSvebs uWirT socialuri adaptacia. isini gvian da rTulad iTviseben socialur Cvevebs: rogor unda moiqcnen ojaxSi, sazogadoebaSi, sazogadoebriv adgilebSi (maRazia, transporti, kafe). aseT bavSvebs, sakuTar asakTan SedarebiT, moumwifebeli socialuri unarebi aqvT.

• bavSvebis moumwifebeloba emociuradac vlindeba. maT SeuZliaT ukiduresad sapirispiro emociebis gamoxat-va, arian impulsurebi da uWirT emociebis kontroli. amave dros, isini Zlier mgrZnobiareni arian garemos damokidebulebisadmi da mwvaved reagireben, rodesac ver grZnoben keTilganwyobas, siTbos da emociur mxar-daWeras. gonebrivi CamorCenilobis mqone bavSvis so-cializacias ojaxisa da sazogadoebis mxridan didi Za-lisxmeva sWirdeba.

ra mizezebi iwvevs gonebriv CamorCenilobas?

gonebrivi CamorCeniloba, SeiZleba, mravali mizeziT iyos gamowveuli. gamoyofen prenatalur (mucldyofnis periodis), perinatalur (mSobiarobis) da postnatalur (dabadebis Semdgom) faqtorebs.

prenataluri faqtorebia: • genetikuri:

_qromosomuli daavadebebi (mag. daunis sindromi, myife

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X sindromi) _metabolizmis Tandayolili darRvevebi (mag. fenilketonuria, galaqtozemia)

• SeZenili: _nayofis alkoholuri sindromi; _dedis infeqciebi (citomegalovirusi, listeriozi); _dedis janmrTelobis sxva mdgomreobebi; _dedis intoqsikacia wamlebiT.

• embrionaluri ganviTarebis adreuli cvlilebebi: _kongenitaluri anomaliebi; _nervuli milis ganviTarebis defeqtebi.

perinataluri faqtorebia:• mwvave placentaruli ukamrisoba;• rTuli mSobiaroba;• asfiqsia;• nayofis qronikuli hipoqsia (Jangbadis ukmarisoba).

neonataluri faqtorebia:• hipoqsiur-iSemiuri encefalopaTia;• intrakranialuri hemoragia;• respiratoruli darRvevebi;• qala-tvinis samSobiaro travmebi;• infeqciebi: meningiti, encefaliti.

postnataluri faqtorebia:• qala-tvinis dazianeba;• infeqciebi (herpesi, sokovani, parazituli infeqciebi,

meningiti, encefaliti);• toqsikur-metaboluri darRvevebi;• gulyriTi sindromebi (vestis sindromi, lenoqs-gastos

sindromi);• garemos qronikuli deprivacia (araxelsayreli yofiTi

pirobebi, Zaladoba da Seuracxyofa, izolireba).

5�

ramdenad xSiria gonebrivi CamorCeniloba?

sxvadasxva qveynebis monacemebiT, gonebrivi CamorCeni-loba aReniSneba saerTo populaciis �%-s. Tumca sxvadas-xva kvlevaSi gavrcelebis gansxvavebuli maCvenebelia, rac damokidebulia gamoyenebul kriteriumebsa da gansazRvre-bebze, aseve sakvlev populaciaze. gonebrivi CamorCenilo-bis Tanxvedra xSiria autizmTan, cerebrul damblsTan, epi-lefsiasTan. SemTxvevaTa 80%-s aReniSneba ioli gonebrivi CamorCeniloba; ��%-s _ saSualo, 7%-s _ Zlieri, xolo �%-s ki mZime.

SefasebabavSvis gonebrivi CamorCenilobis diagnozis dadgenaSi

wamyvani roli klinikur fsiqologs, ganviTarebis pediatrs da bavSvis nevrologs ekuTvniT. diagnostikisaTvis didi mniSvneloba aqvs bavSvis multidisciplinur, anu sxvadasxva specialistis mier Sefasebas.

• dReisaTvis, gonebrivi CamorCenilobis diagnozis dad-gena ori niSnis mixedviT xdeba: inteleqtis testis maCvenebliTa da adaptaciuri funqcionirebis xarisxis maCvenebliT. inteleqtis gazomva xorcieldeba IQ, anu inteleqtis koeficientis sazomi testebiT. isini Sei-caven sxvadasxva tipis davalebebs. testis maCveneble-bi standartizebulia bavSvebis asakis, kulturis, Ti-Toeuli qveynis regionebSi mSobelTa ganaTlebisa da socialur-ekonomiuri statusis mixedviT. inteleqtis testebis meSveobiT SesaZlebelia dadgindes, Tu ra una-rebi gaaCnia bavSvs misi asakobrivi jgufis bavSvebTan mimarTebaSi. Tumca, aucilebelia, testis maCveneblebis metad frTxili interpretacia, romelic mxolod ga-mocdil fsiqologs SeuZlia.

IQ (inteleqtis koeficienti) gamoixateba cifrebSi standartul skalaze romelzec saSualo qulaa �00, xolo standartuli gadaxra _ �6. saSualo, anu 80-��0 Soris qulebi, yvelaze gavrcelebuli maCveneblebia. 70-79 qulebi _ mosazRvre mdgomareobaa, xolo 70-s qvemoT _ gonebrivi

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CamorCenilobis maCvenebelia. amave dros, inteleqtis test-Si dabali maCveneblebi, SeiZleba, sxva faqtorebmac ganapi-robos; magaliTad, ojaxurma mdgomareobam, testis masalis sxva kulturaze pirdapirma gadatanam (testi amerikul kulturaSia Seqmnili) da did populaciaze misi standar-tizaciisa Tu adaptaciis ugulvebelyofam, arasworma tes-tirebam, fsiqologis arasakmarisma kvalifikaciam. amitomaa mniSvnelovani testis Catareba gawvrTvnili specialistis mier da misi maCveneblebis profesiulad kvalificiuri in-terpretacia. xazgasmiT unda aRiniSnos, rom sakmarisi ar aris gonebrivi CamorCenilobis Sefaseba mxolod IQ teste-biT. aseTi midgoma, xSirad, bevr gaugebrobas iwvevs. mag. ori bavSvis erTnair IQ maCvenebelSi igulisxmeba maTi swav-lis erTnairi potenciali, rac ar Seesabameba realobas. erTnairi gonebrivi CamorCenilobis xarisxis da inteleq-tis koeficientis mqone pirebs sxvadasxva SesaZleblobebi da Seguebis sxvadsxva xarisxi gaaCniaT, rasac IQ testi ver gviCvenebs. amitom, aucilebelia, bavSvis Tu mozrdilis adaptaciuri funqcionirebis xarisxis Sefaseba. es termini yvela im unars moicavs, rac damoukidebeli cxovrebisaTvi-saa saWiro: TviTmomsaxurebis, swavlis, SromiTi, socialu-ri, saxlis movlis Cvevebi. aucilebelia, bavSvis socialuri gamocdilebisa da socialuri Cvevebis gaTvaliswineba, ro-melTa Sesafaseblad yvelaze gavrcelebulia ABS (Adaptive Behavior Scales). aRniSnuli skalis saSulebiT xdeba pi-rovnebis Cvevebis Sefaseba sxvadasxva cxovrebiseul sfero-Si, mag. TviTmomsaxurebis, sazogadoebriv adgilebSi qcevis, fulis banknotis gamoyenebis, saxlis movlis, axloblebTan da ucxo pirebTan urTierTobis da a.S. Sesabamisad, goneb-rivi CamorCenilobis xarisxis gansazRvra xdeba ara mxolod intelqtis koeficientis gaTvaliswinebiT, aramed im dax-marebis xarisxis SefasebiT, romelic individs esaWiroeba damoukidebeli cxovrebisa da garemosTan adekvaturi ur-TierTobisaTvis.

gonebrivi CamorCenilobis Sefaseba unda moxdes zemo-aRniSnuli oTxi ganzomilebis mixedviT.pirveli ganzomilebiT pirovnebis mdgomareobis Sefaseba xdeba IQ testebiT da adaptaciuri qcevis Sefasebis ska-

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lebiT. Tu IQ 70-ze dabalia, adaptaciuri qcevis skalebSi orze met sferoSia darRvevebi, maTi dawyebis asaki ki �8 wlamdea, am SemYxvevaSi saxezea gonebrivi CamorCenilobis diagnostikuri kriteriumi.

Sefasebis testebi:

Cvilobis asakSi gamoiyeneba beilis skalebi (�-dan 4� Tvis asakis bavSvebisaTvis);

grifitsis fsiqikuri ganviTarebis skalebi (� Tvidan 8 wlam-de asakis bavSvebisaTvis);

5 wlamde asakis (skolamdeli asakis) bavSvebisaTvis gamoiy-eneba bavSvTa unarebis makkartis skalebi (�.5-8.5 wlis bavS-vebisaTvis), kaufmanis bavSvebis Sesafasebeli batarea K-ABC (�.5-��.5 wlis bavSvebisaTvis), veqsleris skolamdeli asakis bavSvebis inteleqtis skala WPPSI-R (3-5 wlis bavSvebisaT-vis);

5 wlis zemoT da ymawvilebisaTvis gamoiyeneba britanuli unarebis skalebi BAS (�-�8 wlebi), stenford-bines IQ tes-ti (�-�3 wlebi), veqsleris inteleqtis skala bavSvebisaT-vis WISC-R (6-dan �7 wlamde), veqsleris inteleqtis skala mozrdilebisaTvis WAIS-R (�6-74 wlebi).

meore ganzomilebis mixedviT unda Sefasdes bavSvis qceva sxvadasxva situaciaSi da emociuri sferos susti da Zlieri mxareebi. axloblebis interviurebisa da dakvirvebis mona-cemebis garda iyeneben pirovnebis adaptaciuri qcevebis Se-safasebel standartizebul skalebs. yvelaze farTod ga-moiyeneba:

adaptaciuri qcevis skalebi, ABC, romelic standartizebu-lia 3-dan 69 wlamde asakisaTvis. arsebobs misi ori versia: skolisaTvis da institutebisaTvis. misi saSulebiT fasdeba �0 sfero, mag. damoukidebeli funqcionireba, fizikuri ganvi-Tareba, ekonomikuri aqtivoba, Tavis movla da a.S. da �4 prob-lemuri qceva, mag. Zaladoba, destruqciuli qceva da a.S.

vainlendis adaptaciuri qcevis skalebi, romlebic standar-tizebulia 0-dan �9 wlamde. fasdeba 4 sfero _ yoveldRiu-

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ri cxovrebis Cvevebi, komunikacia, socializacia, motoru-li ganviTareba.

bruninqsis damoukidebeli socialuri qcevis skalebiT fas-deba �4 adaptaciuri qceva, romelic 4 qveskalaSia gaerTia-nebuli (motoruli, socialuri interaqcia da komunikacia, yoveldRiuri damoukidebeli cxovrebis Cvevebi, sazoga-doebrivi cxovreba) da 8 dezadaptaciuri saxis qceva, ro-melic 3 sferodaa dajgufebuli (internalizebuli qcevis problemebi, eqsternalizebuli qcevis problemebi, soci-luri dezadaptaciuri qceva).

mesame ganzomilebiT saTanado specialistebis mier fas-deba pirovnebis fizikuri da janmrTelobis mdgomareoba da paTologiuri mdgomareobis etiologiuri faqtorebi.

meoTxe ganzomilebaze unda Sefasdes pirovnebis ojaxuri da saskolo garemo. metad mniSvnelovania, skolaSi da oja-xSi bavSvis Semdegi moTxovnilebebis dakmayofileba da maTi ganxorcielebis xarisxis Sefaseba: normalur sazogadoeb-riv cxovrebaSi CarTvis moTxovnileba; asakisaTvis Sesafe-risi damoukidebeli funqcionirebisaTvis saWiro Cvevebis ganviTarebis moTxovnileba.

bavSvis oTxive ganzomilebis mixedviT SefasebasTan erTad unda Sefasdes saTanado daxmarebis xarisxi. daxma-reba klasificirdeba rogorc perioduli, SezRuduli, eqs-tensiuri da mudmivi. es aucilebeli momentia, radgan mis mixedviT ganisazRvreba, Tu ra saxisa da intensivobis spe-cialuri momsaxureba esaWiroeba pirovnebas saxlSi, skola-Si, sazogadoebaSi da a.S.

idealur SemTxvevaSi jamdeba Sefasebis Sedegebi, aRiwe-reba bavSvis statusi oTxi ganzomilebis mixedviT da bavS-vis mdgomareobis specifikuri moTxovnilebebidan gamomdi-nare, Camoyalibdeba daxmarebis ganxorcielebis konkretu-li gegma.

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ra ZiriTadi problemebi gvxvdeba gonebrivi CamorCenilobis dros?

gonebrivi CamorCenilobis mqone bavSvis ganviTarebas Tavisi kanonzomiereba aqvs, romelic Zlier gansxvavdeba saSualo bavSvis ganviTarebis Cveuli mimdinareobisgan da es gansxvaveba ukve Cvilobis asakidan fiqsirdeba.

mTavari sirTule, rasac mSoblebi awydebian gonebri-vi CamorCenilobis mqone bavSvis aRzrdisas, aris is, rom mas didi dro da didi Zalisxmeva sWirdeba yoveldRiuri Cvevebis, Tu axali informaciis asaTviseblad. imaSi, rasac sxva bavSvebi TiTqosda bunebrivad iTviseben (Wama, Cacma, tualetiT sargebloba, ferebis, formebis, sididis garCeva) gonebrivi CamorCenilobis mqone bavSvs specialuri pirobe-bi da swavleba esaWiroeba.

meore sirTule, romelic xels uSlis gonebrivi Camor-Cenilobis mqone bavSvis ganviTarebas, Cvevis an informaciis ganzogadebis siZnelea. aseTi bavSvisaTvis, erT konkretul situaciaSi aTvisebuli Cvevis, an miRebuli codnis sxva si-tuaciaSi gamoyeneba didi problemaa. maT uWirT sxvadasxva situaciebs Soris msgavsebis danaxva. amitom, TvalsaCinod da praqtikul ganxorcielebaSi sWirdebaT dainaxon, Tu ro-gor xdeba erTi Cvevis an konkretuli codnis sxvadasxva situaciaSi gamoyeneba.

imis gamo, rom bavSvis abstraqtuli azrovnebis ganvi-Tareba Zlier CamorCeba, uWirs zogadi mimarTebis gageba, mizez-Sedegobrivi mimarTebis wvdoma, problemis gageba, Sinaarsidan azris gamotana. bavSvis aRzrdaSi es problema erT-erTi mTavaria.

gonebrivi CamorCenilobis mqone pirebSi emociuri da qcevis darRvevebi SemTxvevaTa �5-50%-Si gvxvdeba; ��-�5%-s _ mxedvelobis, xolo 8-�0%-s smenis poblemebi aqvs; �5-30%-s aReniSneba epilefsia; yoveli �00.000-idan �0-s seriozuli TviTdamazianebeli da saSiSi qceva aqvs.

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rogor davexmaroT gonebrivi CamorCenilobis mqone bavSvs?

rogorc wesi, ojaxisaTvis bavSvis gonebrivi CamorCeni-lobis diagnozis gageba Zlieri stresia. Zalze rTul da mZime gamcdebTanaa dakavSirebuli im azrTan Segueba, rom bavSvis mdgomareoba qronikuli xasiaTisaa da mas ar eqne-ba iseTi momavali, rogorc es ojaxs hqonda warmodgenili. miuxedavad amisa, mdgomareoba arc ise uimedoa. bavSvis Se-saZleblobebis Sesatyvisi aRzrdisa da swavlis pirobebSi, gonebrivi CamorCenilobis mqone bavSvi da Semdeg, mozrdi-li, mSvenivrad egueba socialur garemos.

ras niSnavs Sesatyvisi aRzrda da swavleba gonebrivi Ca-morCenilobis dros?

• pirveli da mniSvnelovani, rac aucilebelia, rom drou-lad Catardes, bavSvis gonebrivi CamorCenilobis xa-risxis dadgenaa. es gulisxmobs ara mxolod imis garkve-vas, Tu risi gakeTeba ar SeuZlia bavSvs, an risi defi-citi aqvs da ras ver axerxebs, aramed imis codnasac, Tu ra SeuZlia, ra moswons, raze reagirebs, rogor iyenebs daxmarebas.

• aucilebelia, Cveni moTxovnebisa da molodinebis misada-geba bavSvis SesaZleblobebTan. gonebrivi CamorCenilo-bis mqone bavSvis aRzrda im potenciuri SesaZleblobe-bis gamovlenasa da ganviTarebas anu bavSvis individua-lobis gaTvaliswinebas niSnavs, rac konkretul bavSvs gaaCnia. unda gavacnobieroT, rom Cveni mizani sakuTari warmodgenisa da survilis mixedviT bavSvis Secvla da misadmi moTxovnebis wayeneba ki araa, aramed bavSvisaTvis misawvdomi gzebiT im unarebis amoqmedeba, romelic mas gaaCnia. amitom, aucilebelia, sakuTari interesebidan da moTxovnilebebidan yuradReba gadavitanoT bavSvis moTxovnilebebze da interesebze. araadekvaturi aR-zrdis pirobebSi (bavSvis mimarT Seusabamod maRali an Seusabamod dabali moTxovnebi) bavSvs im unarebis ganvi-Tarebisa da gamomJRavnebis SesaZleblobac ki ara aqvs, rac mas gaaCnia. magaliTad, yovel mSobels surs, rom mi-

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sma Svilma wera-kiTxva mainc icodes. mZime xarisxis go-nebrivi CamorCenilobis dros simboluri Cvevebis (wera, kiTxva, Tvla) Camoyalibeba ver xerxdeba. mSoblebi ui-medobas eZlevian, radgan maTi molodinebi ar gamarTl-da da bavSvis ganaTlebis mcdelobac sruldeba. xSirad, mSoblebi ver acnobiereben, rom ganaTleba farTo cne-baa da igi mxolod wera-kiTxvisa Tu Tvlis daswavlas ar gulisxmobs; ganaTleba aucilebelia garkveuli Cveve-bis aTvisebis (yoveldRiuri, Tavis movlis, socialuri, SromiTi Cvevebi), garemosTan komunikaciis, adamianebTan urTierTobis sakiTxebSic. rac ufro bevr sxvadasxva si-tuaciaSi miiRebs bavSvi praqtikul gamocdilebas, miT ufro mizanSewonili da adekvaturi xdeba misi qceva.

• aucilebelia, SromiTi saqmianobisaTvis mozardis ukve gardamavali asakidan momzadeba. ioli da saSualo xarisxis gonebrivi CamorCenilobis SemTxvevaSi mozardebi warmate-biT euflebian sxvadasxva xelobasa da profesias. es metad mniSvnelovania maTi emociur-motivaciuri sferos ganvi-Tarebis, pirovnuli zrdisa da damoukideblobisaTvis.

• gonebrivi CamorCenilobis mqone bavSvebis momsaxurebis mizniT sazogadoebaSi unda arsebobdes kargi infra-struqtura: aucilebelia, sabavSvo baRebsa da skolebSi integrirebis programebis arseboba; aseTi bavSvebisa da maTi ojxebis dasaxmareblad, specialur saswavlo pro-gramasTan erTad, unda arsebobdes fsiqikuri ganviTa-rebis stimulirebis programebi da fsiqo-socialuri samsaxurebi; aseve, aucilebelia, aseTi mozardebisa da Semdeg, mozrdilebisaTvis profesiuli orientaciis, dasaqmebisa da xelobis swavlebis centrebis arsebobac.

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SeiZleba Tu ara gonebrivi CamorCenilobis gankurneba?

gonebrivi CamorCeniloba qronikuli mdgomareobaa, rome-lic mTeli cxovrebis ganmavlobaSi Tan axlavs adamians. igi ganviTarebis darRvevaa, romelic centraluri nervuli si-stemis sxvadasxva mizeziT dazianebis Sedegadaa gamowveuli.

Tu zemoxsebuli kiTxva saboloo da srul gamojanmr-Telebas gulisxmobs, maSin pasuxi uaryofiTi iqneba. Tumca, es ar niSnavs imas, rom specialuri mkurnalobiT bavSvis mdgomareobis Secvla SeuZlebelia.

gonebrivi CamorCenilobis mqone bavSvs esaWiroeba ro-gorc medikamenturi mkurnaloba, aseve qceviTi Terapia, fsiqologiuri reabilitacia, samkurnalo-pedagogiuri Ro-nisZiebebis gatareba.

sxvadasxva somaturi problemebis gamo, romelic gone-brivi CamorCenilobis sxvadasxva formas axlavs Tan, bav-Svebs esaWiroebaT simptomuri samedicino mkurnaloba Sesa-bamis specilistebTan.

radganac, gonebrivi CamorCenilobis dros, Tavis tvinis funqcionireba gansxvavdeba Cveulebrivi, saSualo bavSvis Tavis tvinis funqcionirebisa da ganviTarebisagan, aseT ba-vSvebs, xSirad, mkurnaloba eniSnebaT centraluri nervuli sistemis aqtivobis gaumjobesebis mizniT.

intervencia

gonebrivi CamorCenilobis mqone bavSvebisa da maTi oja-xebisaTvis intervenciis programebi moicavs Semdeg xuT sferos:

• fsiqologiuri ganaTleba;

• adekvaturi mxardaWerisa da perioduli Sefasebis orga-nizacia;

• bavSvis yoveldRiuri Cvevebis treningis uzrunvelyofa;

• konsultaciebi mZime qceviTi darRvevebis daZlevis miz-niT;

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• konsultaciebi pirovnebis cxovrebaSi cvlilebebTan dakavSirebiT, ojaxis mxardaWera da konsultaciebi dardis dasaZlevad.

fsiqologiuri ganaTlebagonebrivi CamorCenilobis dros fsiqologiuri gana-

Tlebis mizania ojaxis wevrebis daxmareba bavSvis diagnozi-sa da misgan gamomdinare Sedegebis miRebaSi. ZiriTadi amo-canaa, maTTvis gasageb enaze amomwuravi informaciis miwo-deba da SemdgomSi, diagnozis gagebis stresTan gamklavebis mizniT mSoblebis daxmareba.

adekvaturi daxmarebis organizacia xorcieldeba mul-tidisciplinuri gundis mier. bavSvisa da misi ojaxis daxma-rebis moTxovnilebebi da miznebi mkafiod da gasagebad unda iqnes Camoyalibebuli. daxmarebis konkretuli gegma SeTanx-mebuli unda iyos ojaxTan da gundis wevrebTan. gansazRvru-li unda iyos multidisciplinuri gundis TiToeuli wevris roli daxmarebis gegmaSi da periodul SefasebaSi.

yoveldRiuri Cvevebis treningi gulisxmobs Zalze struqturirebuli da danawevrebuli aqtivobebis Semcvel programebs; maTi meSveobiT mSoblebs aswavlian bavSvebisa-Tvis sxvadasxva Cvevebis aTvisebis saSualebebs. am mizniT gamoiyeneba qcevis modifikaciis proncipebi, Cvevebis Semu-Savebis struqturirebuli programebi, mSoblebisa da sko-lis personalis treningi.

Zlier saziano qcevasTan gamklavebaTviT-saziano, agresiuli da destruqciuli qcevebis Se-

faseba unda moxdes im faqtorebis gamovlenis konteqstSi, romlebic am qcevebs ganamtkiceben. Semdeg ki, am proble-mis gadawyvetis mizniT, bavSvisa da ojaxisaTvis unda mo-xdes programis SemuSaveba. intervenciis programa unda efuZnebodes problemuri qcevis uSualo winmswrebi da misi momdevno movlenebis dawvrilebiT funqcionalur analizs. aucilebelia, farTo ekologiuri xasiaTis Sefasebac fizi-kuri da socialuri garemos im niSnebis gamosavlenad, ro-melic bavSvebsa da maT momvlelebs ganawyobs urTierTgan-mamtkicebeli qcevis gansaxorcieleblad.

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rogor vaswavloT gonebrivi CamorCenilobis mqone bavSvs?

gonebrivi CamorCenilobis mqone bavSvs, iseve rogorc saskolo asakis mis sxva nebismier Tanatols, saskolo ga-remo esaWiroeba saswavlo da funqcionaluri Cvevebis asa-Tviseblad. amitom, misTvis saWiroa specialuri saswavlo programa.

ZiriTadi akademiuri Cvevebis qveS igulisxmeba: wera, ki-Txva, Tvla. amave dros, metad mniSvnelovania e.w. winaaka-demiuri unarebi. specialuri swavlebis saskolo programa did yuradRebas aqcevs iseTi winaakademiuri unarebis Ca-moyalibebas, rogoricaa:

ZiriTadi Cvevebi _ yuradRebis mimarTva da koncentra-cia, mosmena, Tanmimdevrobisa da wesis dacva, miTiTebis TanmimdevrobiT Sesruleba;

metyvelebiTi da komunikaciuri unarebi _ kiTxvebze pa-suxis gacema, kiTxvis dasma, azris gamoxatva;

cnobis unarebi _ sxeulis nawilebis cnoba da dasaxele-ba, ferebis, formebis cnoba;

werisaTvis mosamzadebeli unarebi _ kalmistrisa da fanqris xelSi sworad daWera, xazebis gavleba, martivi fi-gurebis gadaxatva;

kiTxvisaTvis mosamzadebeli unarebi _ siuJeturi sura-Tebis daTvaliereba da moyola, bgerebis garCeva sityvebSi.

gonebrivi CamorCenilobis mqone bavSvTa nawili jer kidev sabavSvo baRSi, an dawyebiT skolaSi, iTvisebs wina-akademiur unarebs. winaakademiuri unarebis Camoyalibebis siswrafe damokidebulia bavSvis gonebrivi CamorCenilobis xarisxze da mis individualur unarebze.

funqcionaluri Cvevebis qveS igulisxmeba iseTi Cveve-bi, romelic sazogadoebaSi yoveldRiuri cxovrebisaTvisaa saWiro:

• TviTmomsaxurebis Cvevebi _ Wama, Cacma, tualeti;

• saxlis movlis Cvevebi _ sawolis gasworeba, oTaxis da-lageba, saWmlis momzadeba, sayidlebze wasvla;

• funqcionaluri kiTxvis Cvevebi _ quCebis dasaxelebebis

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wakiTxva da cnoba, abrebis wakiTxva da cnoba, moZraobis niSnebis cnoba;

• fulad banknotebTan dakavSirebuli funqcionaluri Cvevebi _ fulis niSnebis cnoba, xurdis miReba, daxur-daveba, Tanxis gadaxda;

• sazogadoebrivi cxovrebis Cvevebi _ quCaSi usafrTxod siaruli da quCaze gadasvla, sazogadoebrivi transpor-tis gamoyenebis Cvevebi, SromiTi Cvevebi.zemoT CamoTvlili funqcionaluri Cvevebis asaTvise-

blad Cveulebriv bavSvsac ki bavSvobisa da mozardobis xan-grZlivi periodi esaWiroeba. magram, Tu Cveulebrivi mo-zardi TviTon, bunebrivad axerxebs gamocdilebis SeZenas, gonebrivi CamorCenilobis mqone bavSvs specialuri Zalisx-meva sWirdeba.

gonebrivi CamorCenilobis mqone bavSvebisaTvis ganku-Tvnili specialuri saswavlo programa unda aigos akade-miuri da funqcionaluri Cvevebis aTvisebis balansirebul sistemaze.

gonebrivi CamorCenilobis mqone bavSvis swavlebisas me-tad mniSvnelovania ori sakiTxis garkveva:

• rogor skolaSi unda iswavlos aseTma bavSvma da rogori saswavlo garemo unda hqondes mas?

• rogori unda iyos misi saswavlo programa da rogor unda ganxorcieldes igi?pirvel kiTxvaze pasuxis gacema arc ise iolia. faqtia,

rom bavSvs esaWiroeba saswavlo garemo, magram rogori? sxvadasxva qveynis ganaTlebis sistemaSi am sakiTxis gadasa-Wrelad gansxvavebuli midgomebi arsebobs, amasTan, zoga-dad, SeiZleba sami ZiriTadi strategiis gamoyofa:

• specialuri skolebisa da centrebis momsaxureba, rode-sac gonebrivi CamorCenilobis mqone bavSvi ganaTlebas iRebs misTvis specialurad mowyobil garemoSi;

• integracia, rodesac gonebrivi CamorCenilobis mqone bavSvebi zogadsaganmanaTleblo skolis specialur kla-sebSi swavloben da zogierTi gakveTili, an aqtivobebi Cveulebriv bavSvebTan erTad aqvT;

6�

• sruli CarTva da Tanamonawileoba (inkluzia) rodesac gonebrivi CamorCenilobis mqone bavSvebi, zogadsaganma-naTleblo skolaSi, sakuTari, individualuri progra-miT Cveulebriv bavSvebTan erTad swavloben erT klas-Si.gonebrivi CamorCenilobis mqone bavSvebis zogadsagan-

manaTleblo skolaSi swavlebis momxre da sawinaaRmdego mravali argumenti arsebobs. SeiZleba ramdenime maTganis gamoyofa:

momxre argumentebia:

• janmrTel bavSvebTan urTierTobisas gonebrivi CamorCe-nilobis mqone bavSvi advilad iTvisebs socialur Cvevebs;

• izolacia kidev ufro amZimebs bavSvis mdgomareobas. cno-bilia, rom aseTi bavSvebi konkretuli magaliTebiTa da realuri, konkretuli situaciiT ukeT swavloben, radgan metad mwiri warmosaxvisa da ganzogadebis unari aqvT. ami-tom, gonebrivad CamorCenili bavSvis CarTva sxvadasxva saxis urTierTobebSi, xels uwyobs mis ganviTarebas;

• bavSvi iseTive garemoSi swavlobs, romelSic mas Semd-gomSi mouxdeba cxovreba. es xels uwyobs mis morgebas sazogadoebis moTxovnebTan.

sawinaaRmdego argumentebia:

• gonebrvi CamorCenilobis mqone bavSvs ar gaaCnia sakma-risi Cvevebi da ganviTarebis iseTi done, romelic Cveu-lebriv klasSi warmatebis miRwevis saSualebas miscems. ufro sasargebloa misTvis adekvaturi, specialuri sas-wavlo garemos Seqmna;

• aseTi bavSvis unarebis Tanatolebisagan sagrZnobi gansx-vaveba dabali TviTSefasebis mizezia da SeiZleba klasSi daiCagros;

• zogadsaganmanaTleblo skolas unda SeeZlos gonebrivad CamorCenili bavSvebis specialurad momzadebuli maswav-leblebiT uzrunvelyofa, visac aseT bavSvebTan muSao-

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bis gamocdileba aqvs. realurad ki zogadsaganmanaTle-blo skolas, aseTi bavSvebis swavlebisaTvis, specialurad momzadebuli kadrebi an saerTod ar hyavs, an ar hyofnis;

• specialur skolaSi bavSvis moTxovnilebebisa da Ses-aZleblobebis Sesabamisi garemoa Seqmnili, sadac igi Tavs ufro daculad grZnobs.is, Tu rogori saswavlo garemo unda hqondes bavSvs,

damokidebulia misi gonebrivi CamorCenilobis xarisxze. zogierTi bavSvisaTvis misawvdomi da sasargebloa Cveu-lebriv klasSi swavla, zogierTisTvis _ specialuri klasia adekvaturi, zogs ki specialuri skola esaWiroeba.

yvela SemTxvevaSi, specialuri programis Sinaarsi morge-buli unda iyos bavSvis individualur unar-SesaZleblobe-bze. amitom, aucilebeli da mosaxerxebelicaa, individuri saswavlo programis Sedgena calkeuli bavSvis saWiroebebis gaTvaliswinebiT.

gonebrivi CamorCenilobis mqone bavSvebis swavlebisas gasaTvalsiwinebelia Semdegi faqtorebi:

• klasSi bavSvebis raodenoba unda iyos mcire da ar unda aRematebodes ��-s.

• metad mniSvnelovania maswavlebeli-moswavlis propor-ciis dacva; rac ufro meti maswavlebelia erT moswavle-ze, miT ufro xarisxiania maTi swavleba. zogierT bavSvs individualurad esaWiroeba maswavlebeli,Ê zogierTisa-Tvis ki swavla mcire jgufTan erTadaa efeqturi.

• gonebrivi CamorCenilobis mqone bavSvebis swavlebi-saTvis, zogadsaganmanaTleblo skolas, pirvel rigSi, unda hyavdes specialurad mozadebuli maswavleblebi, xolo bavSvebisTvis Seqmnili unda hqondes Sesaferisi pirobebi. maswavleblebs, romlebic aseT bavSvebs spe-cialuri programiT aswavlian da maTTan individualu-rad muSaoben, unda hqondeT bavSvis anomaluri ganviTa-rebis, swavlebis specialuri meTodebisa Tu midgomebis da aseT bavSvebTan urTierTobis sakiTxebSi saTanado ganaTleba da gamocdileba.

• gonebrivi CamorCenilobis mqone bavSvebis swavlebisas didi mniSvneloba aqvs saskolo dRis wesrigis stru-

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qturas. gonebrivi CamorCenilobis mqone bavSvs uWirs davalebis damoukideblad Sesruleba, axali situaciis damoukideblad gageba da esaWiroeba detaluri miTiTe-bebi. aseTi bavSvebi ukeT swavloben mravaljeradi ga-meorebis Sedegad. amitom, aucilebelia, maTi saskolo ganrigi struqturirebuli iyos da yoveldRiurad xor-cieldebodes erTnairi TanmimdevrobiT. meores mxriv, saWiroa, bavSvma iswavlos Secvlil situaciaSi qceva da erT situaciaSi SeZenili Cvevebis sxva situaciaSi ga-moyeneba. amitom, optimalur dRis wesrigad miCneulia iseTi situacia, rodesac gakveTilebisa da aqtivobebis ganrigi Tu Tanmimdevroba, ZiriTadad, ucvleli rCeba, xolo aqtivobis Sinaarsi da garemo situacia icvleba.

• saswavlo masalebis TvalsaCino stili xels uwyobs go-nebrivad CamorCenili bavSvis mier masalis aTvisebas. aseTi bavSvebis swavlebisas, aucilebelia, ara marto mravalferovani konkretuli TvalsaCino masalis, ara-med TvalsaCino situaciebis gamoyenebac. mag. cxovele-bisa da frinvelebis Seswavlisas, TvalsaCino suraTebis gamoyenebasTan erTad, sasargebloa, Tu arsebobs bavS-vebis zooparkSi wayvanis saSualebac. masala unda iyos asakis Sesaferisi da Seesabamebodes bavSvis interesebs. mag. SesaZlebelia, aseTi me-4 klaseli bavSvis kiTxvis done Seesabamebodes Cveulebrivi pirveli klaseli bavS-vis dones, magram mas ar ainteresebdes teqstis is Sina-arsi, rac tipuri pirvelklaselisTvisaa saintereso.

• aucilebelia, akademiuri da funqcionaluri Cvevebis aTvisebaSi balansis dacva. zogadsaganmanaTleblo skolaSi swavlebis erT-erT Zi-

riTad mizans warmoadgens bavSvis socializacia da es pro-cesi gansakuTrebulad uWirT gonebrivi CamorCenilobis mqone bavSvebs. maTTvis ar arsebobs erTi swori saswavlo programa. asakis gaTvaliswinebiT, mizanSewonilia, TiToeu-li aseTi bavSvisTvis SemuSavdes saTanado swavlebis indi-viduri programa, romlis daxmarebiTac gonebrivad Camor-Cenil bavSvs gauadvildeba axali socialuri Cvevebis aTvi-seba, megobrebis SeZena, Camouyalibdeba adekvaturi TviT-Sefaseba da damoukideblobis grZnoba.

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daswavlis unaris darRveva

ra aris daswavlis unaris darRveva?

daswavlis unaris darRvevis cnebis SemoRebamde far-Tod gamoiyeneboda analogiuri termini _ daswavlis una-ris daqveiTeba (learning disability). is pirvelad �963 wels SemoiRes, xolo ganmarteba �975 wels iqna miRebuli aSS-is federaluri kanonmdeblobis mier. daswavlis unaris darR-veva heterogenuli darRvevebis mqone jgufis zogadi saxe-lwodebaa, romlebic vlindeba kiTxvis, weris, maTematikuri unarebis ganviTrebis deficitSi da savaraudod, dakavSire-bulia centraluri nervuli sistemis disfunqciebTan.

terminiT `daswavlis unaris darRveva~ aRiwereba infor-mciis Senaxvis, gadamuSavebisa da axali informaciis produ-cirebis sxvadasxva saxisa Tu xarisxis dabrkolebebi (aSS swa-vlis uunarobis nacionaluri komiteti _ NJCLD); IDEA-is (SezRuduli SesaZleblobebis mqone individTa ganaTlebis aqti) mixedviT, daswavlis unaris daqveiTebis gansazRvreba gulisxmobs Semdegs:

�. bavSvs darRveva aqvs im erT an ramdenime bazisur fsi-qikur procesSi, romlebic safuZvlad udevs zepiri da weriTi metyvelebis gagebasa da gamoyenebas; igi vlinde-ba mosmenis, azris gamoTqmis, weris, kiTxvis, artikula-ciis, Tvlis siZneleebSi.

�. bavSvs sirTuleebi aqvs swavlaSi, kerZod, uWirs wera-kiTxvisa da maTematikis aTviseba.

3. swavlis problemebis mizezs ar warmoadgens sensoruli deficiti (smenis da mxedvelobis daqveiTeba), motoru-li nakli, gonebrivi CamorCeniloba, emociuri aSlilo-ba, ekonomikuri, garemosa da socialur-kulturuli araxelsayreli pirobebi.

4. didi gansxvavebaa bavSvis swavlis potencialsa da misi miRwevis dabal dones Soris.

5. daswavlis unaris darRveva ukavSirdeba centraluri nervuli sistemis disfunqcias (anu problemas biolo-giuri safuZveli aqvs).

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6. daswavlis unaris darRveva SeiZleba arsebobdes sxva darRvevebTan erTad (mag. emociuri aSliloba, yuradRe-bis deficitisa da hiperaqtivobis sindromi).

7. problema SesaZlebelia arsebobdes mTeli cxovrebis manZilze.

daswavlis unaris darRveva mravali forma arsebobs. am tipis darRvevaTa speqtri imdenad farToa, rom daswavlis unaris darRvevis mqone ori erTnairi bavSvis moZebna, pra-qtikulad, SeuZlebelia. daswavlis unaris darRveva SeiZ-leba adamians mTeli cxovreba hqondes; zog SemTxvevaSi, igi moicavs adamianis cxovrebis farTo sferos, sxva SemTxveva-Si ki warmoadgens izolirebul problemas.

warsulSi, daswavlis unaris darRvevis aRsaniSnavad, iyenebdnen Semdeg terminebs: Tavis tvinis minimaluri dis-funqcia, disleqsia, hiperaqtivoba.

dRes fsiqiuri aSlilobebis diagnsotikur saxelmZRva-neloebSi daswavlis unaris darRvevis gansazRvrebebi mci-red gansxvavdeba DSM-IV-isa da ICD-10-is mixedviT:

DSM-IV-TR ICD-10daswavlis unaris darRveva

akademiuri unarebis specifikuri ganviTa-rebis darRvevebi F81

3�5.00 kiTxvis una-ris darRveva

F81.0 kiTxvis unaris specifikuri darRveva

F81.1 marTlweris specifikuri darRveva

3�5.� maTematikuri unaris darRveva

F81.2 maTematikuri unarebis specifikuri darRveva

F81.3 akademiuri unarebis Sereuli darR-veva

F81.8 akademiuri unarebis ganviTarebis sxva darRvevebi

3�5.9 daswavlis unaris darRvevis dauzustebeli darR-veva

F81.9 akademiuri unarebis ganviTarebis dauzustebeli darRveva

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rogorc cxrilidan Cans, ICD-10-Si, gansxvavebiT DSM-IV-gan calkea gamoyofili marTlweris, orTografiis speci-fikuri darRvevebi da akademiuri unarebis Sereuli darR-veva.

daswavlis unaris darRvevis diagnostirebisas metad mniSvnelovania diferencireba gakeTdes:

gonebriv CamorCenilobasTan ICD-10, F70; sensoruli deficitiT gamowveul ganviTarebis pro-

blemebTan (smenisa da mxedvelobis daqveiTeba), ICD-10, IV ganzomileba;

ganviTarebis pervesiul aSlilobebTan ICD-10, F84;metyvelebis ganviTarebis specifikur darRvevebTan

ICD-10, F80;pedagogiur xelmiSvebulobasa da arasrulfasovan swav-

lebasTan ICD-10, V ganzomileba.

ra axasiaTebs daswavlis unaris darRvevas?

bavSvebis garkveuli kategoria, visac skolaSi Sesvla-mde TiTqos ganviTarebis problemebi ar hqonia, skolaSi swavlisas siZneleebs awydeba. maswavleblebze isini, xSirad, uyuradRebo, zarmaci, uintereso moswavlis STabeWdilebas toveben, rac naklebad Seesabameba sinamdviles.

daswavlis unaris darRveva, pirvel rigSi, akademiur moswrebaSi vlindeba, radgan, bavSvs, SeiZleba, aRmoaCndes weris, kiTxvis, maTematikis aTvisebis siZneleebi.

daswavlis unaris darRvevis daxasiaTeba sakmaod rTu-lia, radgan igi yovel konkretul SemTxvevaSi gansxvavebul xasiaTs atarebs. zogadad, SeiZleba iTqvas, rom swavlis si-Zneleebs bevri sxvadasxva mizezi SeiZleba edos safuZvlad. am dros bavSvis fsiqikuri ganviTareba mozaikur xasiaTs atarebs, rac fsiqikuri funqciebis araTanabar ganviTare-bas gulisxmobs.

daswavlis unaris darRvevis mqone bavSvebis zogierTi funqcia kargad aris ganviTarebuli, zogierTi ki ganviTa-rebaSi Seferxebuli, an darRveulia. zog SemTxvevaSi, Ziri-

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Tadi problema mxedvelobiT-sivrciTi funqciis darRveve-bia: bavSvs uWirs marjvena-marcxena mxaris garCeva, sagnebis sivrciTi ganlgebis warmodgena, xatva. amave dros, uZnelde-ba ariTmetikuli operaciebis aTviseba, mravalniSna ricxve-bis wakiTxva, saaTis cnoba, rac sivrciT analizs moiTxovs. zogierT SemTxvevaSi, problema metyvelebis funqciebSia. gansakuTrebiT es exeba: azris winadadebaSi Camoyalibebas _ gamonaTqvams da sxvisi sityvieri instruqciis, an sxvisi monayolis interpretacias. aseT bavSvs uWirs maswavleblis mier axsnili masalis gageba, maswavleblis miTiTebis Ses-ruleba, TanatolebTan urTierToba da gakveTilis moyola. sxva SemTxvevaSi problema, SeiZleba, daxvewil motorul kontrolsa da natif moZraobebSi iyos. aseT dros bavSvs uWirs daimaxsovros, Tu rogor unda Semoxazos da ra mo-Zraobebi akeTos asos dawerisas. zogierT SemTxvevaSi, pro-blemas warmoadgens Tanmimdevrul moqmedebaTa regulacii-sa da kontrolis darRveva. saskolo moswrebis warmateba bevradaa damokidebuli bavSvis unarze gaigos da swori TanmimdevrobiT Seasrulos davalebaTa seriebi, damouki-deblad SeZlos davalebis Sesruleba. am SemTxvevaSi bavSvs uWirs Tanmimdevruli moqmedebebis Sesruleba zedamxedve-lobis gareSe, uZneldeba miyves maswavleblis miTiTebas da Seasrulos ise, rom TviTon akontrolos sakuTari Secdo-mebi.

aseTi bavSvebi impulsurebi arian, uWirT damoukideblad moqmedeba da davalebis Sesruleba. zogjer, maT xanmokle mexsierebisa da yuradRebis problemebi aqvT, rac aqveiTe-bs maTi daswavlis efeqturobas. yuradRebis deficitisa da hiperaqtivobis sindromi SeiZleba zogjer, magram ara yo-velTvis, Tan axldes swavlis unaris daqveiTebas.

daswavlis unaris darRvevis mqone bavSvs didi kompensa-toruli SesaZleblobebi gaaCnia; erTi fsiqikuri funqciis deficitis SemTxvevaSi igi kompensacias sxva ganviTarebuli funqciebis xarjze axdens. amitom, pirvel klasebSi, Sesa-Zloa, daswavlis unaris daqveiTebis sindromi arc ki gamo-vlindes. mogvianebiT, rodesac datvirTva izrdeba, masala matulobs da rTuldeba, bavSvi veRar axerxebs kompensire-bas da sirTuleebic warmoCindeba.

69

daswavlis unaris darRvevis mqone bavSvi Zlier gani-cdis sakuTar warumateblobas skolaSi. igi bevrs cdilobs, Tumca garSemo myofebi amas naklebad Tu amCneven. mas mainc aRiqvamen rogorc zarmacs, uinteresosa da dabali motiva-ciis mqones (moundomebels), ris gamoc xSirad aZleven Se-niSvnebs da akritikeben. maswavleblebi da mSoblebi, xSi-rad, ver xvdebian, Tu ra xdeba bavSvis Tavs, radgan igi ar hgavs gonebrivad CamorCenils.

daswavlis unaris darRvevis mqone bavSvebi gamoirCevian dabali TviTSefasebiTa da SfoTvis maRali doniT. aRniS-nul sindroms, xSirad, Tan axlavs emociuri problemebi da zogjer, emociuri sferos darRvevac ki. aseTi bavSve-bis umravlesoba, gansakuTrebiT gardamaval asakSi, guls icruebs swavlaze da Znelad aRsazrdeli mozardebis jguf-Si inacvlebs.

ra saxis daswavlis unaris darRveva arsebobs?

D. Doehring iyo pirveli mecnieri, romelic neirofsiqo-logiurad ikvlevda daswavlis unaris darRvevis mqone ba-vSvebs da gamoyofda darRvevis verbalur da araverbalur qvetipebs.

daswavlis unaris darRvevaSi ganasxvaveben:verbaluri daswavlis unaris darRveva _ eqspresiuli

da impresiuli metyvelebis funqciebis deficiti, weris, kiTxvis problemebi. aRmocendeba upiratesad Tavis tvi-nis marcxena hemisferos disfunqciis dros;

araverbaluri daswavlis unaris darRveva _ sivrciTi orientaciis, Tvlis da ariTmetikuli unaris, socialu-ri aRqmis daqveiTeba. aRmocendeba upiratesad marjvena hemisferos disfunqciis dros (Myklebust, 1978; Rourke, 1975, 1979).

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raSi gamoixateba araverbaluri daswavlis unaris darRveva?

es sindromi pirvelad aRweres Myklebust-ma da Johnson-ma (1971) da maTve daukavSires Tavis tvinis marjvena hemis-feros deficits.

Rourke (�975, �979, �990) intensiurad ikvlevda araver-baluri daswavlis unaris darRvevis neirofsiqologiur ma-xasiaTeblebs. amitom, aRniSnuli termini, ZiriTadad, mis saxels ukavSirdeba.

Rourke-s mixedviT araverbaluri daswavlis unaris darRveva Semdegi niSnebiT xasiaTdeba:

sxeulis marcxena mxares taqtiluri aRqmis gaZneleba;

motoruli koordinaciis deficiti;

vizualur-sivrciTi organizaciis problema;

sirTuleebi araverbaluri problemis gadawyvetaSi, hipoTezebis SemowmebaSi;

iumoris gagebis simwire;

maTematikuri unarebis deficiti;

axal situaciasTan Seguebis problema;

metyvelebis prosodikis darRveva;

socialuri aRqmis deficiti.

am sindromis mqone bavSvebs kargi verbaluri mexsiereba aqvT, problemebi ar gaaCniaT marTlweraSi, kiTxvaSi, meqa-nikur daswavlaSi. amave dros, maT problemebi aReniSnebaT emociur regulaciaSi, metyvelebis pragmatul funqciaSi (enis adekvaturi gamoyeneba konteqstis da situaciis Sesa-bamisad), socialuri situaciis gagebaSi, interpersonalur urTierTobebSi da maTematikis aTvisebaSi (Rourke, �979, �990).

aRniSnuli sindromis diagnostireba ukve 8-9 wlis asakiTvisaa SesaZlebeli. daswavlis unaris darRveva aRe-niSneba zogadi populaciis �0%-s, romelTagan �% _ araver-baluri daswavlis unaris daqveiTebis mqonea.

7�

ra aris daswavlis unaris darRvevis mizezi?

daswavlis unaris darRvevis mizezi centraluri nervu-li sistemis funqcionirebis deficitia, romelic sxvadasxva xarisxisaa da xSirad, centraluri nervuli sistemis da-zianebis gamoxatuli niSnebi, rogorc klinikur-nevrolo-giuri, ise neirovizualuri gamokvlevebiT ar vlindeba. amis gamo, winaT, aseT mdgomareobas Tavis tvinis minimalur disfunqcias uwodebdnen.

Tavis tvinis funqcionirebis dificiti SeiZleba vlinde-bodes sensoruli integraciis darRvevaSi. es niSnavs, rom bavSvis Tavis tvinSi kargad ver xerxdeba miRebuli sensor-uli da motoruli informaciis mowesrigeba da organizacia. bavSvs, samedicino TvalsazrisiT, TiTqos yvelaferi wes-rigSi aqvs, magram xSirad, daswavlisa da qcevis problemebi gaaCnia. mis Tavis tvins uWirs sxvadasxva arxebiT, garedan da Signidan miRebuli sensoruli informaciis dakavSireba da konkretul situaciaSi relevanturi gamoyeneba. vinaidan, aseT SemTxvevaSi, Tavis tvinis funqcionirebas ̀ dazianebuls~ ver davarqmevT, aRniSnuls vuwodebT `disfunqcias~. magali-TisaTvis, SesaZlebelia, Semdegi Sedarebis moyvana: rodesac kuWi, sxvadsxva mizezis gamo, saTanadod ar funqcionirebs, adgili aqvs saWmlis monelebis problemebs, magram kuWi, Ta-visTavad, SeiZleba dazianebuli ar iyos (J. Aires, 1979).

daswavlis unaris darRveva garkveul SemTxvevebSi, Sei-Zleba, vlindebodes Tavis tvinis disfunqciis ioli nev-rologiuri niSnebi an Tavis tvinis raime anatomiuri Ta-viseburebebi; es ukanaskneli, SeiZleba, gamovlindes bavSvis Tavis tvinis neirovizualuri gamokvlevebiT (kompiuteru-li tomografia, birTvul - magnitur-rezonansuli gamokv-leva, pozitronul-emisiuri tomografia).

daswavlis unaris darRveva SeiZleba garemos mavne ze-moqmedebebma (haeris da wylis ekologiuri dabinZureba, ty-viiT mowamvla, mavne nivTierebebis dedaze da nayofze zemo-qmedeba, infeqciebi) gamoiwvion. ekologiurma dabinZurebam, SeiZleba, imoqmedos bavSvis centraluri nervuli sistemis ganviTarebaze. misi aRmoceneba ar aris damokidebuli so-cialur mdgomareobaze, aRzrdaze, swavlebis xarisxze.

7�

ra sixSiriT gvxvdeba daswavlis unaris darRveva?

DSM-IV-is monacemebiT mosaxleobis �-�0%-s daswavlis unaris darRvevis romelime forma aqvs da TiTqmis erTnairi sixSiriT gvxvdeba qalebsa da mamakacebSi. gavrcelebis ase-Ti farTi diapazoni gamowveulia sxvadasxva kvlevaSi gamo-yenebuli gansxvavebuli kriteriumebiTa da SefasebebiT. msoflios sxvadasxva qveynis monacemebiT, aRniSnuli prob-lema skolis moswavleTa 5-7%-s aReniSneba.

ra ZiriTadi problemebi gvxvdeba daswavlis unaris darRvevis dros?

• cxadia, mTavar da ZiriTad problemas warmoadgens saskolo programis daZlevis sirTuleebi. bavSvs uWirs wera-kiTxvis, Tvlis aTviseba da codnis SeZenaSi mas ver exmareba zogadsaganmanaTleblo skolaSi gavrcelebuli swavlebis meTodebi.

• am ZiriTad problemasTan dakavSirebulia bavSvis piro-vnebis ganviTarebis problemebic. bavSvi klasSi sakuTar Tavs sxvebs adarebs da Zlier ganicdis warumateblo-bas. igi cdilobs maqsimaluri gaakeTos, magram ise ar gamosdis, rogorc saWiroa an rogorc sTxoven. amitom, xSirad ar aris darwmunebuli sakuTar SesaZleblobebSi; misi yvelaze xSiri frazaa: `me ar SemiZlia amis gakeTe-ba!~ rac ufro mtkicdeba bavSvis warumatebloba skola-Si, swavlaze miT ufro metad icruebs guls. misTvis skola wvalebasTan da damcirebasTanaa asocirebuli. amitom, cdilobs ipovos iseTi situacia, sadac ar iq-neba ukanaskneli da sadac eqneba warmatebis sasiamovno gancda. daswavlis unaris darRvevis dros xSiria pro-blemebi emociur sferoSi: maRali SfoTva, emociuri aramdgradoba, SiSebi, agresia. es arTulebs bavSvis ga-remosTan, ufrosebTan da TanatolebTan urTierTobas. zemoaRniSnuli mizezebis gamo aseT bavSvebs, gardama-val asakSi, antisocialuri qcevis didi riski gaaCniaT.

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rogor davexmaroT daswvlis unaris darRvevis mqone bavSvebs?

pirvel rigSi, aucilebelia, bavSvis rac SeiZleba drou-li da swori fsiqologiuri diagnostika. ojaxi daswavlis unaris darRvevis problemis winaSe, xSirad, bavSvis skolaSi Sesvlis Semdeg aRmoCndeba xolme. maSin, rodesac, skolam-del asakSi rac ufro adre moxdeba bavSvis fsiqikuri ganvi-Tarebis problemebis gamovlena da specialuri daxmarebis organizeba, miT ufro srulfasovani iqneba bavSvis sasko-lo mzaoba.

xSirad, aseT bavSvebs, samedicino SemowmebiT aranairi paTologia ar aReniSnebaT da aucilebeli xdeba fsiqolo-giuri diagnostika. Tu skolamdel bavSvs sensomotoruli integraciis problemebi aqvs, uWirs TiTebiT zusti, natifi moZraobebis Sesruleba, marjvena-marcxena mxareSi orienta-cia, obiqtebis sivrciTi mimarTebebisa da ganlagebis cnoba, Tvalisa da xelis koordinacia, ambis moyola, mas Zalze gauWirdeba saswavlo programis aTviseba.

vinaidan, daswavlis unaris darRveva yovel bavSvSi indi-vidualurad vlindeba, aucilebelia misi unar-SesaZleblo-bebis, Zlieri da susti mxareebis dawvrilebiT aRwera. ama-ve dros, mniSvnelovania, ojaxis wevrebis informacia imis Sesaxeb, Tu ra SeuZlia bavSvs, ra uWirs, ra moswons. yove-live es aucilebelia jer kidev skolamdel asakSi bavSvis sensoruli integraciis problemebis, metyvelebis, yura-dRebis Tu mxedvelobiT-sivrciTi funqciebis ganviTarebi-saTvis, specialuri damxmare RonisZiebebis dagegmvisaTvis. rac ufro drouli da miznobrivi iqneba bavSvis daxmareba, miT ufro naklebi sirTuleebi eqneba skolaSi.

daswavlis unaris darRvevas mravalferovani gamovli-nebebi aqvs da Zalian mniSvnelovania, misi diagnostireba, raTa ar moxdes misi aRreva gonebriv CamorCenilobasTan, autizmTan, qceviT aSlilobasTan, sensoruli deficitiT gamowveul daswavlis problemebTan. fsiqologiuri diag-nostireba xdeba bavSvze dakvirvebiT, mSoblebis interviu-rebiT, neirofsiqologiuri testirebiT.

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rogor SeiZleba daswavlis unaris darRvevis mkurnaloba?

arsebobs mkurnalobis sxvadasxva forma: farmakolo-giuri preparatebiT, fizikuri varjiSebiT, specialuri pe-dagogiuri da fsiqologiuri daxmarebiT. daswavlis unaris darRvevis mqone bavSvebs, yvelaze metad, ukanaskneli saxis mkurnaloba esaWiroebaT. bavSvis fsiqologiuri Sefasebis Semdeg, aucilebelia, mSoblebsa da maswavleblebs miewodos informacia bavSvis mdgomareobis Sesaxeb; aseve, fsiqolo-giuri konsultacia unda CautardeT bavSvisaTvis adekva-turi swavlebis strategiis SemuSavebis mizniT.

daswavlis unaris darRvevis mqone bavSvebis mkurnalo-ba, pirvel rigSi, gulisxmobs bavSvis SesaZleblobebidan gamomdinare specialur, individualur saswavlo gegmis Se-muSavebas da mis Tanmimdevrul ganxorcielebas. aseT ba-vSvebTan maswavlebeli, fsiqologi, okupaciuri Terapevti da metyvelebis Terapevti erToblivad muSaoben. isini er-Toblivad qmnian individualur saswavlo gegmas, romel-sac klasis maswavlebeli ganaxorcielebs bavSvis saswavlo procesSi efeqturi CarTvis mizniT. saswavlo programa eyrdnoba SemovliT strategiebs; es niSnavs, rom daswavlis problemebis daZleva da susti mxareebis ganviTareba xdeba SemovliTi gziT - im unarebis gamoyenebiTa da stimulire-biT, romelic bavSvs kargad aqvs ganviTarebuli. amis pa-ralelurad bavSvTan, misi saWiroebebidan gamomdinare in-dividualurad muSaobs fsiqologi, metyvelebis Terapevti an okupaciuri Terapevti misi susti mxareebis, jer kidev moumwifebeli unarebis ganviTarebis mizniT.

Tu bavSvis fizikuri mdgomareoba moiTxovs, pediatrisa da nevrologis konsultaciis Semdgom, SeiZleba, medikamen-tebic daeniSnos.

sakmaod mavnea bavSvis aramiznobrivi mkurnaloba. daswa-vlis unaris darRvevis pedagogiur-fsiqologiuri mkurna-loba xangrZlivi procesia; igi mTlianad moicavs bavSvis swavlas, TamaSs, cxovrebas.

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verbaluri daswavlis unaris darRvevebi

kiTxvis unaris specifikuri darRveva

kiTxvis unaris darRveva daswavlis unaris darRvevis erT-erTi gamovlinebaa da SesamCnevi xdeba bavSvis skolaSi wasvlis Semdeg. Tumca, aRsaniSnavia, rom kiTxvisaTvis sa-Wiro unarebis momwifebaSi problemebis identifikacia jer kidev skolamdel asakSia SesaZlebeli.

kiTxvis unaris darRvevis ZiriTad niSans warmoadgens ro-gorc sityvebis wakiTxvis sirTule Cumad an xmamaRla, aseve wakiTxulis gaazreba. kiTxvis unaris darRvevis diagnosti-kisaTvis metad mniSvnelovania is faqti, rom bavSvis kiTxvis done bevrad ufro dabalia, vidre misi asakis Sesabamisi in-teleqtualuri ganviTareba. erT-erTi diagnostikuri kri-teriumia mniSvnelovani gansxvavebaa asakis Sesabamis kiTxvis donesa da inteleqtis maCvenebels Soris. misi Sefaseba, bu-nebrivia, xdeba asakis Sesabamisi standartizebuli kiTxvis testisa da inteleqtis testis Sedegebis SedarebiT.

pirvelive klasSi bavSvs eqmneba anbanis aTvisebis, aso-ebis garCevisa da maTi sityvad gaerTianebis problemebi. ufro mogvianebiT bavSvs SeiZleba aReniSnos Semdegi pro-blemebi kiTxvaSi:

kiTxvis neli tempi;

gamotoveba, damaxinjeba an damateba sityvebis an sityvis nawilebis;

`striqonis dakargva~, frazis arazusti wakiTxva, si-tyvis mravaljeradi gameoreba;

sityvebis winadadebaSi, an asoebis sityvaSi gadaadgileba;

wakiTxulis Sinaarsis moyolis SeuZlebloba;

wakiTxuli teqstidan azris gamotanisa da daskvnis gake-Tebis SeuZlebloba (ICD-10, 2003).kiTxvis specifikur darRvevebs anamnezSi win SeiZleba

uswrebdes metyvelebis ganviTarebaSi specifikuri Seferxe-ba, an metyvelebis normaluri ganviTarebis pirobebSi sme-niTi an mxedvelobiTi informaciis gadamuSavebis sirTule-ebi.

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kiTxvis specifikuri darRvevis diagnostikisas dife-rencireba unda gakeTdes:

SeZenil disleqsiasa da aleqsiasTan (kiTxvis SeZenil darRvevasTan) ICD-10, R48.0;

marTlweris, orTografiis specifikur darRvevasTan ICD-10, F81.1;

bavSvobis asakis emociur aSlilobasTan, meoradi ki-Txvis unaris darRveva ICD-10, F93;kiTxvis unaris darRvevis sinonimebia:

ganviTarebis disleqsia;

kiTxvis aTvisebaSi specifikuri Seferxeba;

CamorCena kiTxvaSi.

qvemoT ganvixilavT kiTxvis unaris darRvevis yvelaze ga-vrcelebul sinonims – ganviTarebis disleqsias.

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disleqsia

ra aris disleqsia?

disleqsia berZnuli sityvaa: dys niSnavs mcires, lexis niSnavs sityvebs. disleqsia pirvelad me-�0 saukunis da-sawyisSi aRweres k. morganma da j. hinSelvudma. s. ostonma me-�0 saukunis �0-ian wlebSi aRwera mdgomareoba romel-sac strefosimbolia uwoda, anu sapirispiro sivrciTi ganlagebis, magram msgavsi asoebis garCevis uunaroba (mag. x,Z,l,d,p,k). disleqsia viwro mniSvnelobiT _ kiTxvis unaris daqveiTebas, farTo mniSvnelobiT ki _ metyvelebiT gaSu-alebuli daswavlis unaris daqveiTebas niSnavs, romelic xasiaTdeba kiTxvis, werisa da zepiri metyvelebis proble-mebiT. disleqsia ar aris dabali inteleqtis Sedegi. igi arc qceviT, motivaciur, an socialur problemas warmo-adgens. disleqsiis mqone bavSvebs smenac da mxedvelobac wesrigSi aqvT. bevr maTgans SemoqmedebiTi azrovneba aqvs. disleqsiis SemTxvevaSi mniSvnelovani gansxvavebaa swavlis potencialsa da saskolo miRwevebs Soris. msoflio nevro-logTa federaciam (�968) ganviTarebis disleqsia ganmarta, rogorc adekvaturi inteleqtis, socialur-ekonomikuri da kulturuli keTildReobisagan damoukideblad ganvi-Tarebuli darRveva, romelic vlindeba kiTxvis aTvisebis sirTuleebSi da xSirad konstituciuri xasiaTisaa. disleqsiis mqone bavSvebis jgufi mravalferovania.gamoyofen disleqsiis Semdeg saxeebs:

�. genetikuri, anu memkvidreobiTi disleqsia: xasiaTdeba ojaxuri SemTxvevebiT; msgavsi problemebi aqvT ojaxis sxva wevrebs, axlo naTesavebs da es problemebi Taobebs gadaecema.

�. ganviTarebis disleqsia _ kongenitaluri, dabadebidan arsebuli da ganviTarebis procesSi gamomJRavnebuli, magram ara memkvidreobiTi.

orive tipis disleqsia miekuTvneba pirvelad, anu specifikur disleqsias _ kiTxvis unaris darRvevas.

3. SeZenili disleqsia _ mogvianebiT aRmocendeba raime

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fizikuri mdgomareobis, an dazianebis gamo (travmebi, hipoqsia). es simptomaturi disleqsiaa.pirvelad disleqsiebSic gamoyofen qvetipebs, Tumca,

klasifikaciis safuZveli, SeiZleba, gansxvavebuli iyos:

• disfonetikuri kiTxvis unaris daqveiTeba _ asosa da bgeras Soris mimarTebis gagebis siZnele. am SemTxvevaSi adgili aqvs sityvis fonetikuri analizis darRvevas, sityvis wakiTxva vizualuri niSnebis xarjze xdeba;

• diseideturi kiTxvis unaris daqveiTeba _ sityvis mTlianobaSi aRqmis da wakiTxvis darRveva. am SemTx-vevaSi SeuZlebelia sityvebis vizualuri konfiguraciis cnoba, Tumca fonetikuri analizi SesaZlebelia.

• disfonetikur-diseideturi kiTxvis unaris daqveiTeba _ rogorc asosa da bgeras Soris mimarTebis gagebis da iden-tifikaciis, ise mTliani sityvis wakiTxvis problema.

L tipis disleqsia _ kiTxvisas darRveulia marjvena hemis-ferosaTvis damaxasiaTebeli strategiebi;

P tipis disleqsia _ kiTxvisas darRveulia marcxena hemis-ferosaTvis damaxasiaTebeli strategiebi.

es dayofa eyrdnoba Tavis tvinis funqciuri asimetriis models; ama Tu im fsiqikuri funqciis uzrunvelyofaSi Ta-vis tvinis orive hemisfero monawileobs, magram amave dros, yovel maTgans upiratesoba aqvs fsiqikuri unaris, am SemTx-vevaSi kiTxvis romelime konkretuli mxaris uzrunvelyo-faSi. dasawyisSi, rodesac bavSvi kiTxvas swavlobs, asoebis konfiguraciis, sityvebis formis da mimarTulebis gas-arCevad, aucilebelia perceptuli analizi. am procesebs marjvena hemisfero uzrunvelyofs. amitom, kiTxvis Cvevis aTviseba sawyis stadiaze damokidebulia marjvena hemisfer-os mobilizaciaze da ganviTarebis doneze. mas Semdeg, rac bavSvi aiTvisebs fonemis grafemul Sesatyvisobas, kiTxvis Cvevis aTvisebaSi wamyvani xdeba marcxena hemisferos aq-tivoba. am stadiaze kiTxva moqnili, swrafi da avtomatize-buli xdeba.

Tu upiratesobis gadacema ar moxda marjvena hemisfer-odan marcxenaze, maSin individs problemebi eqneba kiTxvaSi

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da ecdeba perceptuli niSnebis mixedviT wakiTxvas, Ses-abamisad, waikiTxavs nela da fragmentulad. es aris P tipis disleqsia. am tipis disleqsiis mqone individisaTvis aso obieqtad ufro aRiqmeba, vidre simbolur niSnad.

agreTve, marcxena hemisferos mier upiratesobis aRe-ba problemebs iwvevs kiTxvis sawyis etapze. kiTxvis dros marcxena hemisferos strategia efeqturia, radgan teqs-tis perceptuli niSnebis garCeva avtomaturad xdeba. Tu am strategiis gamoyeneba manamde moxda, maSin individi swrafad kiTxulobs, magram bevr Secdomebas uSvebs. es L tipis disleqsiaa (Bakker, Licht, 1998).

disleqsiebis klasifikacia Bakker-is mixedviT

qvetipi kiTxvis perceptuli tipi _ P disleqsia

kiTxvis lingvisturi tipi _ L disleqsia

kiTxvis upira-tesi strategia

vizualur-sivrciTi lingvisturi (fonologiuri).

upiratesi hemisfero

marjvena marcxena

kiTxvis stili neli, fragmentuli, akuratuli.

swrafi, uzusto, asoe-bis gamotovebiT.

mkurnaloba marcxena hemisferosstimulacia:•iribi stimulaciis teqnika;•specifikuri stimulaciis teqnika.

marjvena hemisferos stimulacia:•iribi stimulaciis teqnika;•specifikuri stimu-laciis teqnika.

disleqsiis diagnozi ismeba im SemTxvevaSi, rodesac bavSvis kiTxvis maCveneblebi saSualo doneze gacilebiT dabalia da ar Seesabameba bavSvis zogad inteleqtualur ganviTarebas.

Rutter, Yule (1975) erTmaneTisgan ganasxvaveben: �. kiTxvis specifikur Seferxebas; �. kiTxvaSi zogad CamorCenas. pirveli ganisazRvreba, rogorc normaluri inteleqtis

fonze kiTxvis aTvisebaSi mZime CamorCena. igi mniSvnelovan

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kavSirSia metyvelebis adreul darRvevebTan da samjer xSi-ria mamakacebSi. misi aRmocenebis maRali genetikuri riski aqvT ojaxebs, sadac kiTxvis specifikuri siZneleebi mam-robiTi sqesis individebs aReniSnebaT. meore saxis darRveva Tan axlavs dabal IQ maCveneblebs da erTnairi sixSiriT gvx-vdeba qalebsa da mamakacebSi. igi dakavSirebulia nevrolo-giur deficitTan, vizualur-motoruli unarebis deficit-Tan da araxelsayrel socialur garemosTan.

Rourke, Petrauskas-ma (�979), neirofsiqologiuri defi-citis mixedviT, gamoyves kiTxvis aTvisebis daqveiTebis sami qvetipi:• metyvelebis problemebi da Senaxuli vizualur-motor-

uli unarebi _ Tavis tvinis marcxena safeTqlis qerqis deficiti;

• vizualuri mexsierebis, Tanmimdevrobis aRqmisa da dax-somebis, TiTebis identifikaciis deficiti _ Tavis tvi-nis marcxena hemisferos kuTxis xveulis dazianeba;

• metyvelebisa da cnebis Camoyalibebis deficiti vizua-lur-motoruli unarebis daqveiTebasTan erTad _ Tavis tvinis marcxena Sublis wilis deficiti.

riT xasiaTdeba disleqsia?

qvemoT CamoTvlili niSnebidan bavSvs SeiZleba hqondes zogierTi an ramodenime maxasiaTebeli da ar aRmoaCndes yvela maTgani. yvelaze gavrcelebuli maxasiaTeblebia:

• kiTxvis aTvisebis problema;

• weris aTvisebis problema;

• wakiTxulis gagebis sirTule;

• ariTmetikuli operaciebis warmoebis sirTule, rac da-kavSirebulia moqmedebis Tanmimdevrobisa da sivrciTi mimarTebebis analizis problemebTan;

• sityvaSi bgerebisa da maTi Tanmimdevrobis, marcvlebis Tanmimdevrobis aRqmis (fonologiuri analizis) sir-Tule;

8�

• sityvis damarcvlis da marcvlebis sityvaSi gaerTianebis (fonologiuri analizis) sirTule;

• verbaluri moqnilobis moumwifebloba;

• verbaluri xanmokle mexsierebis daqveiTeba;

• ricxvSi cifrebisa da sityvebSi asoebis Tanmimdevrobis aRqmis sirTule;

• muSa mexsierebis problemebi;

• sivrciTi da drois mimarTebebis aRreva;

• marjvena-marcxena mxareebSi orientaciis problema;

disleqsiis xarisxi yvela SemTxvevaSi sxvadasxvaa. prog-nozi damokidebulia yovel individualur SemTxvevaSi bavS-vis Zlieri da susti mxareebis specifikaze da intervenciis programis Sesabamisobaze.

kiTxvis darRvevebis mixedviT:• L (lingvisturi) - disleqsiis mqone bavSvebi swrafad

kiTxuloben, magram bevri uzustobebi aqvT, toveben asoebs, amokleben, toveben an amaxinjeben sityvebs. iT-vleba, rom am dros kiTxvisas ufro aqtiuria bavSvis marcxena hemisfero.

• P (perceptuli) – disleqsiis mqone bavSvebi ufro nela, magram ufro zustad kiTxuloben. kiTxvisas akliaT mo-qniloba. sityvebs imeoreben, kiTxuloben fragmentu-lad, marcval-marcval, Tumca sworad. iTvleba, rom am dros upiratesad aqtiuria marjvena hemisfero.

• problemebi kiTxvaSi, werasa da saskolo miRwevebSi bavSvis ganviTarebisaTvis sxva, meorad arasasurvel problemebs iwvevs, romelTa gaTvaliswineba aucilebe-lia disleqsis Sefasebisas.

• disleqsiis mqone bavSvebi Zalian mgrZnobiareni arian SeniSvnebisa da kritikis mimarT, bavSvi xSirad iwyebs tirils, rodesac raimes ver kiTxulobs, an weris dros raime Secdomas uSvebs. maT uaryofiTi gamocdileba aqvT akademiuri Cvevebis aTvisebasTan dakavSirebiT, rac gavlenas axdens emociuri sferos ganviTarebaze da pirovnebis formirebaze.

• imis gamo, rom maswavleblebi da mSoblebi naklebad gaT-vicnobierebulni arian dislqsiis maxasiaTeblebsa Tu

8�

daxmarebis strategiebSi, bavSvebi maTi mxridan xSirad ganicdian damcirebas, dacinvas, ignorirebas, SeniSvnebs da uxeS mopyrobas. yovelive es damTrgunvelad da Seur-cxmyofelad moqmedebs bavSvze da iwvevs: gulCaTxrobi-lobas, dabal TviTSefasebas, daurwmuneblobas, qcevis problemebs; rac SeiZleba gamoixatos skolis persona-lis mimarT agresiul reaqciebSi, daumorCileblobaSi, asocialur qcevaSi, hiperaqtivobaSi.

• araswori mkurnalobisa da Seuferebeli saswavlo pro-gramis Sedegad bavSvebs uCndebaT saswavlo situaciisa da skolis personalis mimarT SiSi, zizRi, xSirad uars amboben skolaSi siarulze, irCeven izolacias, aReniS-nebaT emociuri gauwonasworebloba, fsiqosomaturi tkivilebi; am simptomebma, SeiZleba, seriozuli xasi-aTic ki miiRos.Morris-is (�988) mixedviT kiTxvis specifikuri dar-

Rvevebi gansaxvavdeba fonologiuri deficitis, vizualuri diskriminaciis, Tu vizualuri Tanmimdevrobis mexsierebis deficitis xarisxis mixedviT. kiTxvis specifikuri darRve-vis qvetipebis gaTvaliswinebiT kiTxvis swavlebis special-uri programebis Sedgena sakmaod rTulia.

ra aris disleqsiis mizezi?

disleqsiis gansxvavebul etiologiur faqtorebs aRniS-naven:

• genetikuri, memkvidreobiTi faqtori. gamokvlevebis Sedegad aRmoCnda, rom disleqsiis mqone pirebis na-Tesavebs msgavsi darRvevebi an problemebi hqondaT. iTvleba, rom memkvidreobiTi faqtorebi disleqsiis 60%-mde SemTxvevaSi gvxvdeba. ukanaskneli monacemebiT, disleqsiaze pasuxismgebelia me-6 qromosomis mokle mxa-ri. STamomavlobaze misi gadacemis tipi dominanturia.

• neiroganviTarebis deficiti, rac gulisxmobs bavSvis Tavis tvinis im qerquli zonebis, an maT Soris kav-Sirebis deficits, romelic uzrunvelyofs kiTxvisaT-vis aucilebel vizualur (aso)-fonologiuri (bgera)

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asociaciebis Camoyalibebas, maT sinTezs. aRniSnuli deficiti eqtopiis, nayofis Tavis tvinis Camoyalibebis periodSi neironebis migraciis procesis darRvevis Sedegia. centraluri nervuli sistemis ganviTarebis am periodSi mimdinareobs neironebis saTanado mimar-TulebiT masiuri gadaadgileba da winaswar gansaz-Rvruli adgilmdebareobis dakaveba. neironuli migra-ciis Sedegad yalibdeba Tavis tvinis qerquli zonebi da qerqqveSa struqturebi. zogjer, neironuli migraciis procesi irRveva da neironebi an scdebian daniSnulebis adgils, an ver aRweven mas. Sesabamisad, isini SecdomiT aRmoCndebian Tavis tvinis qerqis maTTvis araadekvatur adgilebSi da qmnian atipur neironul kavSirebs. tvinis qerqis eqtopia yalibdeba mucladyofnis periodis me-6 Tvemde da iqmneba eqtopiuri neironebis gansxvavebuli neironuli wreebi.

• cacioba da alergiuli daavadebebi xSiradaa dakavSire-buli kiTxvis problemebTan.

• Tavis tvinis funqciuri asimetriis disbalansi, rac kiTx-vis procesis ganxorcielebisas iwvevs marjvena da mar-cxena hemisferos erToblivi funqcionirebis darRvevas. Cveulebriv, kiTxvis swavlis sawyis periodSi, rodesac mimdinareobs asoebis aRqma, garCeva, maTi sivrciTi niS-nebis analizi, dominirebs marjvena hemisfero; Semdgom etapze, rodesac iwyeba asoebisa da sityvebis bgeriTi, fonologiuri niSnebis garCeva, upiratesobas marcxena hemisfero iRebs. disleqsiis dros irRveva marjvena da marcxena hemisferos strategiebis adekvaturi gamoyene-ba (Bakker, Licht, 1998).

funqciuri asimetriis disbalansi anatomiur done-zec vlineba. normaluri mkiTxvelebis Tavis tvinisa-gan gansxvavebiT, dislqsiis mqone pirebis Tavis tvinis safeTqlis wilebi simetriulia.

• Tvalis moZraobis, mzeris moqnili kontrolis deficiti, romelic informaciis dekodirebas uSlis xels.

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rogoria disleqsiis sixSire?

sxvadasxva qveynis monacemebiT skolis asakis bavSvebis �5%-s kiTxvis problemebi aqvs. aSS monacemebiT skolis mo-swavleTa 4%-s aReniSneba kiTxvis unaris darRveva. disleq-sia gvxvdeba yvela kulturaSi da yvelanair socialur jgufSi. gavrcelebuli iyo mosazreba imis Sesaxeb, rom ma-makacebSi disleqsia ufro xSiria, vidre qalebSi. ukanaskne-li epidemiologiuri monacemebis mixedviT disleqsiis six-Sire mniSvnelovnad ar gansxvavdeba sqesis mixedviT.

ra ZiriTadi problemebi gvxvdeba disleqsiis dros?

disleqsiis mTavari problemaa kiTxvis aTvisebis unaris daqveiTeba.

• bavSvs uWirs sityvebis fonologiuri analizi, damar-cvla, calkeuli bgerebis erT sityvad gamTlianeba;

• gaZnelebulia simboloebsa da bgerebs Soris mimarTebis damyareba;

• bavSvs aqvs fonologiuri informaciis Senaxvis defici-ti, rac xels uSlis asoebis, sityvebis gaxmovanebasa da gamoTqmas;

• aReniSneba asoebis erT sityvaSi gaerTianebis proble-ma;

• uWirs sityvis fonematuri analizi (mag. aris Tu ara aso `k~ sityvaSi soko);

• kiTxvis dros darRveulia ritmi da sunTqva;

• SeiZleba adgili hqondes Tvalis moqnili moZraobebis dieficits, rac sityvis horizontaluri aRqmisTvisaa saWiro;

• skolaSi warumatebloba iwvevs qcevisa da emociuri sfe-ros problemebs, rac kidev ufro arTulebs akademiuri Cvevebis dauflebas.

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rogor unda davexmaroT dislqsiis mqone bavSvs?

• bavSvis pirveli da mniSvnelovani daxmarebaa misi pro-blemis sworad Sefaseba da diagnostireba. aucilebelia, gamokvleul da dadgendil iqnas is mizezebi, ris gamoc bavSvis akademiuri moswreba CamorCeba Tanatolebs. disleqsiis Sefasebisas aucilebelad unda iqnas gaTva-

liswinebuli:

bavSvis janmrTelobis mdgomareoba;

ojaxis istoria;

zogadi inteleqtis done;

emociuri sfero;

bavSvis SemecnebiTi funqciebis mdgomareoba;

gansakuTrebuli gulisyuriT unda Sefasdes kiTxva, wera, impresiuli da eqspresiuli metyveleba.

bavSvi unda Seafasos bavSvTa nevrologma, neirofsiqo-logma, metyvelebis Terapevtma da pedagogma.

metad mniSvnelovania, ojaxis, neirofsiqologisa da maswavlebelis urTierTTanamSromloba. informaciis Sesa-groveblad, aucilebelia, mSoblisa da maswavleblis inter-viureba, qcevis Sesafasebeli skalebis gamoyeneba, smenisa da mxedvelobis rutinuli samedicino gamokvleva. bavSvis akademiuri Cvevebis Sesafaseblad gamoiyeneba fsiqometru-li testebi. wina saskolo, skolis asakisa da mozrdilebis gamosakvlevad yvelaze xSirad iyeneben farTo speqtris mi-Rwevebis tests _ WRAT, Wilkinson, (�993). agreTve iyeneben veqsleris individualuri miRwevis tests (WIAT, Rust, 1995), veqsleris IQ tests, an unarebis britanul tests (BAS).

• Semdegi nabijia bavSvis Zlieri da susti mxareebis ga-TvaliswinebiT misi kiTxvis an weris problemebis daZle-vis mizniT individualuri saswavlo programis Seqmna

• Tu diagnostika droulia (pirvelive klasSi), maSin ba-vSvisTvis metad mniSvnelovania sensoruli integraciis Terapia, rac xels uwyobs bavSvis sensomotoruli in-

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tegraciis deficitis daZlevas. xSirad, disleqsiisa da sxva swavlis problemebis mqone bavSvebs aReniSnebaT sensoruli integraciis deficiti, romelic samedicino gamokvlevebiT ar vlindeba.

• aucilebelia, ojaxisa da skolis TanamSromloba da maTi erTiani strategia. aseT bavSvebs Zlieri mxardaWe-ra esaWiroebaT mSoblebisa da maswavleblebis mxridan. keTilganwyobisa da mxardaWeris pirobebSi disleqsiis mqone bavSvebi Tavs daculad grZnoben, ar sZulT saswa-vlo procesi da xalisiT asruleben davalebebs.

SesaZlebelia Tu ara disleqsiis gankurneba?

disleqsiis mkurnaloba farmakologiuri preparate-biT ar xdeba. disleqsia sxvadasxva xarisxisaa, Sesabamisad, prognozi damokidebulia rogorc bavSvis SesaZleblobebze ise garemo situaciaze, swavlebis adekvaturi pirobebze da bavSvisadmi damokidebulebaze. efeqturi da drouli dax-marebis SemTxvevaSi bavSvebi gadalaxaven kiTxvisa da mar-Tlweris problemebs, Tumca, garkveul SemTxvevebSi, ki-Txvis problema mTeli cxovrebis ganmavlobaSi rCeba.

disleqsiis mqone adamians kiTxvisa da marTlweris swa-vlebisaTvis esaWiroeba specialuri programa, radgan igi Cveuli gziT ver iTvisebs aRniSnul akademiur Cvevebs.

rogor vaswavloT disleqsiis mqone bavSvs?

saerTod, kiTxvis specifikuri darRvevis _ disleqsiis etiologia, tradiciulad, kiTxvis Cvevebis ganviTarebis ori Teoriis konteqstSi moiazreba:

fonologiuri Teoria Tvlis, rom kiTxvis swavlisas ba-vSvma jer unda SeZlos asos da bgeris dakavSireba da Semdeg es fonemuri blokebi gamoiyenos sityvebis wakiTxvisa da gamoTqmisaTvis. ZiriTadi argumentia is, rom bavSvi awyobs sityvas, mag. sityva Txa, sami bgerisagan Sedgeba, romlebic `T~ `x~ da `a~ asoebs Seesabameba.

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mTlianenobrivi Teoriis mixedviT bavSvi jer mTliani sityvebis cnobas swavlobs da ara calkeuli asoebisa Tu bgerebis SeerTebas. am Teoriis mixedviT ucnobi sityvebis bgerebi daiswavleba konteqstSi sityvis mniSvnelobis mi-xvedriT, rasac xels uwyobs maswavleblis mxridan aqtiuri ukukavSiri. amitom, bavSvisaTvis bgerebis erToblioba Txa, rogorc sityva `Txa~ JRers imitom, rom igi aRiqmeba Txis gamosaxulebasTan mTlianobaSi, an situaciis amsaxvel wina-dadebaSi, mag. `Txa Wams balaxs~.

fonologiur Teorias eyrdnoba kiTxvis swavlis fo-nologiuri meTodi, romlis saSualebiTac bavSvi swavlobs yoveli asos Sesabamis bgeras. mTlianenobrivi Teoria ki safuZvlad udevs konteqstualuri swavlebis meTodebs, mag. `Sexede da daasaxele~ _ am meTodiT bavSvi mTlian sityvas swavlobs konteqstSi.

romelime Teoriis upiratesoba ar dgindeba eqsperimen-tuli gamokvlevebiT. bavSvebi, Cveulebriv, iyeneben rogorc fonologiuri dekodirebis, ise mTlianenobriv konteqstu-alur strategiebs, maTi kiTxvis unarebis ganviTarebis do-nis, masalis nacnobobisa da motivaciis donis mixedviT.

disleqsiis mqone bavSvis swavlebaSi mTavar mizans war-moadgens bavSvis mier bgerebTan Sesatyvisi asoebis dakavSi-reba da maTi diferencireba. am SemTxvevaSi e.w. konteqstu-aluri swavlebis meTodi naklebefeqturia, Tumca, pirvel etapze xels uwyobs kiTxvisadmi dadebiTi ganwyobis Camoya-libebas, rac aranakleb mniSvnelovnia. kiTxvisa da weris Cvevebis aTvisebisas disleqsiis mqone bavSvebs esaWiroebaT mxedvelobis, smenis da xelebismoZraobis SeTanxmebuli mu-Saobis swavla. amitom, aseTi bavSvebis swavlebis erT-erTi efeqturi meTodia multisensoruli swavleba, romelic s. ortons ekuTvnis.

kiTxvisa da marTlweris swavlebisas xdeba mxedvelobiTi (ras vxedavT), smeniTi (ra gvesmis) da kinesTetikur-taqtilu-ri (ras SevigrZnobT) arxebis urTierTdakavSireba. amitom, maswavlebelma erTdroulad unda gamoiyenos vizualuri, fonetikuri da kinesTetikuri meTodebi. mag. rodesac bavSvs erTmaneTSi ereva `S~ da `w~ aso-bgerebi, maT gasarCevad am asoebis sxvadasxvanairi gamoxazva unda aswavlon.

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kiTxvis multisensoruli swavlebisas saWiroa masalis organizeba elementarulidan rTulisaken. yoveli Semdegi nabiji ukve daswavlilis ganmtkicebas da sistematur ga-meorebas efuZneba. maswavlebeli xelmZRvanelobs winaswar Sedgenili programiT, romelic konkretuli bavSvis indivi-dualur moTxovnilebebs Seesabameba.

bavSvisaTvis sityvebis fonematuri analizis, sityvebis bgeriTi Semadgenlobis, aso-bgeris mimarTebis swavleba xdeba rogorc sinTezuri, ise analituri meTodiT, radgan am dros SegrZnebaTa samive arxi aqtiuradaa CarTuli.

kiTxvisas bavSvis konkretuli problemis safuZvelze iqmneba individuri, specialuri savarjiSoebi imis gaTva-liswinebiT, Tu ra saxis problema aqvs bavSvs kiTxvisas; amis safuZvelze xdeba specialuri savarjiSoebis miwodeba: mTliani sityvebi naxatebiT, winadadeba siuJetiT, mxolod sityvebi da teqsti sxvadasxva zomis SriftiT, an ramdenime gaferadebuli asoTi; specialuri teqnikis gamoyeneba aso-bgeris mimarTebis gasamtkiceblad marcvlebisa da asoebis kubikebiT TamaSi: awyoba, Canacvleba, SeerTeba da a.S., plas-teliniT asoebis gamoZerwva da sityvebis awyoba.

bavSvis waxaliseba mniSvnelovnad zrdis Cvevebis gamo-muSavebis efeqturobas. SeniSvnas aucileblad unda hqon-des bavSvisaTvis misaRebi forma da formulirebuli unda iyos mSvidi toniT. bavSvi unda grZnobdes maswavleblis mxardaWeras.

Tu bavSvi zogadsaganmanaTleblo skolis Cveulebriv klasSi swavlobs, maswavlebelma klasSi unda Seafasos si-tuacia da Caataros profilaqtikuri RinisZiebebi, raTa bavSvi daicvas Tanatolebis dacinvisagan. yovelTvis sasar-gebloa bavSvebis Zlieri mxareebisa da maT SesaZleblobe-bis xazgasma, bavSvebTan saubari imaze, rom yvela adamiani gansxvavebulia, yvelas sxvadasxva raime exerxeba.

bavSvis dasaxmareblad efeqturia kiTxvis swavlebis spe-cialuri meTodebis gamoyeneba rogorc saxlSi, aseve sko-laSi.

• wyvilSi kiTxva. Zalian efeqturia kiTxvis procesSi mSo-blebis monawileoba. am strategiis mixedviT mSobeli zis bavSvis gverdiT da masTan erTad kiTxulobs xmamaR-

89

la. am fazaSi mSobeli bavSvs usworebs Secdomebs, aZle-vs sityvis sworad gamoTqmis magaliTs. rodesac bavSvi mzad aris damoukidebeli kiTxvisaTvis, mSobeli araver-balurad aniSnebs bavSvs, rom Cumad iqneba da mousmens mis kiTxvas. Tu bavSvi Secdomebs uSvebs, an ver axerxebs sityvis gamoTqmas, araverbalurad aniSnebs mSobels da igi exmareba bavSvs: sworad gamoTqvams sityvas bavSvTan erTad. wyvilSi kiTxvis meTodi eyrdnoba vigotskis mo-dels.

• simultanuri zepiri marTlwera. marTlwerisadmi mul-tisensoruli midgomebidan erT-erTi efeqturi meTo-dia simultanuri oraluri marTlweris meTodi. bavSvs jer sityvas aZleven gadasawerad.; igi iwers models da gadaweris procesSi xmamaRla gamoTqvams yovel asos. am-denad, gamoiyeneba smeniTi, vizualuri, kinesTetikuri modalobebi sityvis gamoTqmisa da marTlweris swavli-sas. yoveli cdis Semdeg bavSvs moeTxoveba, Seamowmos gadawerili sityvebis asoebi. sami Tanmimdevruli swori cdis Semdeg procedura meordeba, magram bavSvs axla ukve sityvis reproduqcia evaleba. es procedura sami dRis ganmavlobaSi meordeba sxvadasxva sityvebze. aseTi multisensoruli meTodi SeiZleba Cveulebrivi saswa-vlo procesis farglebSi iqnes gamoyenebuli. Tumca, praqtika gviCvenebs, rom ufro efeqturia specialuri jgufuri muSaoba, rodesac bavSvebs aqvT TamaSis, Seji-bris situacia da maRali motivacia.

am meTodisaTvis yoveldRiurad �0 wuTia gamoyofili. gamosaTqmeli sityvebis sia ar unda iyos xuTze meti. erTi da igive sia sami dRis ganmavlobaSi unda meordebodes. ase rom kviraSi sul �0 sityva iswavleba.

• dawereT sityva an sityva aawyveT asoebisgan, gamoTqviT xmamaRla da auxseniT bavSvs misi mniSvneloba.

• TxoveT bavSvs gadaweros, an aawyos sityva da amave dros xmamaRla gaimeoros yoveli bgera.

• TxoveT bavSvs, models Seadaros mis mier kopirebuli sityva.

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• rodesac bavSvi sworad gadawers sityvas da gamoTqvams asoebs, TxoveT, cota xans kargad Sexedos sityvas da daimaxsovros. amis Semdeg daafareT sityvas furceli da TxoveT, aRadginos, TviTon daweros da Tan xmamaR-la gamoTqvas asoebi.

• TxoveT bavSvs Seamowmos, sityvis asoebi Seesabameba Tu ara models. Tu bavSvi sam cdaSi sworad wers sityvas da asaxelebs asoebs, gadadiT Semdeg sityvaze.

• aseTi wesiT 5 sityvaze unda ivarjiSoT sami dRis ganma-vlobaSi.

pedagogiuri TvalsazrisiT metad sasargebloa aqtiuri kiTxvis meTodis gamoyeneba verbaluri daswavlis prob-lemebis mqone iseT bavSvebTan, visac uWirs wakiTxulis gageba. maswavlebeli am meTods nabij-nabij axorcielebs:

pirveli nabiji _ teqstis skanireba, qveTavebis, an abzacebis aRniSvna;

meore nabiji _ teqstis mixedviT kiTxvebis Sedgena, romelzec bavSvma unda upasuxos detaluri kiTxvis dros;

mesame nabijia _ yoveli seqciis wakiTxva SekiTxvis mixedviT da Semdeg pasuxis Cawera.

meoTxe nabiji _ yoveli seqciisaTvis am proceduris dam-Tavrebis Semdeg unda waikiTxon kiTxvebi da pasuxebi.

mexuTe nabiji _ kiTxvaze zepiri pasuxebis gacema.

meeqvse nabijia _ gacemuli pasuxebis sisworisa da sizustis Semowmeba.

meSvide nabiji _ masalis vizualur-sivrciTi warmodgena, daxatva, sqemis gamosaxva.

9�

rogor xdeba disleqsiis Sefaseba?

kiTxvis unaris viwro SefasebisaTvis dasavleTSi iyene-ben kiTxvis standartul testebs. amave dros, bavSvis akade-miuri Cvevebisa da inteleqtis Sesafaseblad gamoiyeneba in-telqtisa da miRwevis fsiqometruli testebi. srulyofili suraTis misaRebad, aucilebelia, informaciis mopoveba ara mxolod bavSvis fsiqologiuri gamokvlevisa da mis qcevaze uSualo dakvirvebis meSveobiT, aramed mSoblisa da maswav-leblis interviurebis Sedegadac.

9�

metyvelebis darRvevebi

Sesavali

metyvelebis darRvevebi Zalze mravalferovania. maT gansxvavebuli buneba da mizezebi aqvT. Tumca, yvela SemTxve-vaSi darRveulia garemosTan enis saSualebiT komunikacia.

darRvevebi SeiZleba aRmocendes metyvelebis fonolo-giur, gramatikul, semantikur, pragmatikul doneze.

fonologiuri siZneleebi vlindeba artikulaciis gaZne-lebaSi, msgavsi artikulemebis (ufro Tanxmovnebis) gamoTq-mis siZneleebSi; xSiria sityvebSi maTi gamotoveba, Secvla, reduqcia-Semokleba.

sintaqsis, anu gramatikuli problemebi vlindeba sxva-dasxva sirTulis winadadebis araswori gramatikuli kon-struqciis gamoyenebaSi, qvemdebaris brunvis, raodenobis da a.S. swori aRniSvnis sirTuleebSi.

semantikuri donis sirTuleebi vlindeba imaSi, rom bavSvs aqvs Raribi leqsikoni, uWirs sityvis sxvadasxva mniSvnelobis gageba, sityvis niSvnelobis gafarToeba, sityvebis gaxseneba.

pragmatikis problemebi vlindeba enisa da Jestebis moce-mul konkretul konteqstSi, situaciaSi gamoyenebis sirTule-Si. 5 wlamde viTardeba pragmatikis aqtiuri gamoyenebis una-ri, rac Cans ambis moyolis, situaciuri dialogebis dros.

garda amisa, metyvelebis darRvevaSi gvxvdeba e.w. mo-qnilobis problemebi. esenia enaborZikoba da metyvelebis uwesrigo xasiaTi. pirveli gulisxmobs metyvelebis dros marcvlebis, sityvebis gameorebebs, bgeris gaxangrZlivebas, pauzis da riTmis darRvevebs; ukanaskneli ki - metyvelebis tempisa da riTmis mouwesrigeblobas.

metyvelebis darRvevebis klasifikacia

metyvelebis darRvevebis klasifikacia DSM-IV-TR-is mixed-viT:komunikaciuri darRvevebi

�. eqspresiuli metyvelebis darRveva (3�5.3�);�. receptul-eqspresiuli metyvelebis Sereuli dar-

93

Rveva (3�5.3�);3. fonologiuri darRvevebi (3�5.39);4. enaborZikoba (307.0);

Cvilobis, bavSvobis, an mozardobis asakis sxva darRvevebi 5. seleqtiuri mutizmi.

metyvelebis darRvevebis klasifikacia ICD-10-is mixedviT:

I. metyvelebis ganviTarebis specifikuri darRvevebi (II F80):�. artikulaciis specifikuri darRveva (II F80.0);�. eqspresiuli metyvelebis darRveva (eqspresiuli ti-

pis ganviTarebis afazia, eqspresiuli tipis ganviTa-rebis disfazia) (II F80.�);

3. receptuli metyvelebis darRveva (receptuli tipis ganviTarebis afazia, receptuli tipis ganviTarebis disfazia) (II F80.�);

4. afazia epilefsiiT (landau-klefneris sindromi) (II F80.3);

5. metyvelebis sxva darRvevebi (II F80.8);6. metyvelebis ganviTarebis darRveva, dauzustebeli

(II F80.9);II. socialuri funqcionirebis darRvevebi, romlebic ZiriTa-dad bavSvobisa da mozardobis asakSi iwyeba:

7. eleqtiuri mutizmi (I F94.0);III. socialuri funqcionirebis sxva darRvevebi, romlebic ZiriTadad bavSvobisa da mozardobis asakSi iwyeba:

8. enaborZikoba (I F98.5);9. uwesrigo metyveleba (I F98.6);

IV. moZraobebisa da SegrZnebebis disociaciuri darRvevebi:�0. fsiqogenuri afonia, disfonia (I F44.4).

metyvelebis darRvevebis klinikur-pedagogiuri klasifika-cia rusuli logopediuri skolis mixedviT:

I. gamonaTqvamis fonaciuri (garegani) gaformebis darRveva (am darRvevebs metyvelebis warmoTqmiTi mxaris darRvevebsac uwodeben):

�. disfonia (afonia) – xmis aparatis paTologiuri cvli-

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lebebis Sedegad fonaciis darRvevebi, an uqonloba. disfonia vlindeba xmis Zalis, simaRlisa da tembris darRvevebSi;

�. metyvelebis tempis cvlilebebi (metyvelebis paTo-logiurad Senelebuli tempi - bradilalia da metyve-lebis paTologiurad swrafi tempi - taqilalia);

3. enaborZikoba - metyvelebis tempisa da riTmuli or-ganizaciis darRveva;

4. dislalia - bgerebis warmoTqmis darRveva normalu-ri smenisa da sametyvelo aparatis SenarCunebuli inervaciis dros (sinonimebi: bgeraTwarmoTqmis de-feqtebi, fonetikuri defeqtebi, fonemebis warmoTq-mis xarvezebi);

5. rinolalia – xmis tembrisa da bgeraTwarmoTqmis darRvevebi, romlebic ganpirobebulia sametyvelo aparatis anatomiur-fiziologiuri defeqtebiT. ri-nolaliis dros dislaliisagan gansxvavebiT damaxin-jebulad warmoTqvamen ara calkeul bgerebs, aramed yvela bgeras;

6. dizarTria - bgerebis mkafiod gamoTqmis darRveva (ganpirobebulia centraluri nervuli sistemis or-ganuli dazianebiTa da sametyvelo aparatis inerva-ciis organuli ukmarisobiT).

II. gamonaTqvamis struqturul-semantikuri (Sinagani) darRveva:7. alalia – metyvelebis ganviTarebis specifikuri

darRveva, ganpirobebulia Tavis tvinis metyvelebis zonebis dazianebiT mucladyofnis an adreul (e.w. metyvelebamde) periodSi (sinonimebi: disfazia, bavS-vTa adreuli afazia, ganviTarebis disfazia);

8. afazia – metyvelebis sruli an nawilobrivi dakar-gva. gamowveulia Tavis tvinis metyvelebis zonebis lokaluri dazianebiT.

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sxvadasxva klasifikaciebis terminologiis Sejereba

ICD-10 DSM-IV-TRrusuli logopediuri

skola

artikulaciis

specifikuri

darRvevafono

logi

uri

dar

Rve

va

dislalia, sinonimebi:

bgeraTwarmoTqmis

defeqtebi, fonetikuri

defeqtebi, fonemebis

warmoTqmis xarvezebi

eqspresiuli

metyvelebis

darRveva

eqsp

res

iul

i

metyv

eleb

is d

ar-

Rve

va

motoruli alalia

sinonimebi: motoruli

disfazia, bavSvTa

adreuli motoruli

afazia, ganviTarebis

motoruli disfazia.

receptuli

metyvelebis

darRveva

rec

eptul

-eqs

pre-

siul

i me

tyv

eleb

is

Sereu

li

dar

Rve

va sensoruli alalia

sinonimebi: sensoruli

disfazia, bavSvTa

adreuli sensoruli

afazia, ganviTarebis

sensoruli disfazia.

afazia epilefsi-

iT (landau-kle-

fneris sindromi)

afazia

enaborZikoba

enab

orZi

koba

enaborZikoba

96

uwesrigo

metyvelebataqilalia

seleqtiuri

(eleqtiuri)

mutizmi

sel

eqtiu

ri

(el

eqtiu

ri)

mutiz

mi

fsiqogenuri

afonia, disfonia

afazia (araklasi-

ficirebuli)afazia

disfonia, afonia

rinolalia

dizarTria

metyvelebis ganviTarebis darRvevebze amomwuravi war-modgenis Seqmnis mizniT teqstSi ICD-�0-is mixedviT sadiag-nostikuri kriteriumebis garda mocemulia sxvadasxva dar-Rvevebis sadiagnostiko kriteriumebi DSM-4-is mixedviTac.

rogoria metyvelebis darRvevis sixSire?

eqspresiuli metyvelebis ganviTarebaSi CamorCena aRe-niSneba � wlis asakis bavSvebis �7%-s, samwlianebis _ 8%-s da xuTwlianebis _ 3 %-s. xuTi wlis asakisaTvis bavSvebis umetesoba kompensirebulia da umklavdeba metyvelebis Se-ferxebiT gamowveul problemebs. 6-7 wlis asakis bavSvebis �-3%-s fonologiuri darRvevebi aqvs, Tumca �7 wlisaTvis es darRveva mxolod 0.5-�%-Si rCeba, umetesad mamakacebSi. enaborZikoba gvxvdeba bavSvebis �%-Si, SedarebiT xSiria ma-makacebSi. SemTxvevaTa 60% spontanurad ukuviTardeba �6

97

wlamde. mamkacebsa da qalebs Soris metyvelebis ganviTa-rebis darRvevebis Sefardebaa 3:�, an 5:�, rac gviCvenebs, rom aRniSnuli darRvevebi mamkacebSi ufro xSiria.

metyvelebis ganviTarebis Seferxebis mqone bavSvebSi arcTu iSviaTia qcevis Tanmxlebi problemebi, rac gansa-kuTrebiT xSirad gvxvdeba metyvelebis mZime eqspresiuli-impresiuli darRvevis dros da uvlindeba eqspresiul-im-presiuli metyvelebis darRvevis mqoneTa 95%-s, eqspresi-uli metyvelebis darRvevis mqoneTa 45%-s, xolo artiku-laciuri darRvevebis mqoneTa �9%-s.

metyvelebis ganviTarebis specifikuri darRveva (ICD-10)

metyvelebis specifikuri darRvevebis mqone bavSvebi heterogenuli jgufia; isini gansxvavdebian metyvelebis ganviTarebis darRvevis xarisxiT, misi sxvadasxva mxareebis upiratesi deficitiT.

bavSvis metyvelebis ganviTarebis darRvevis Taname-drove gansazRvreba Benton (1964)-s ekuTvnis da gamoricxvis princips eyrdnoba. mocemul gansazRvrebaSi amosaval deb-ulebas warmoadgens Tu ra ar aris metyvelebis specifikuri darRveva. bavSvs metyvelebis ganviTarebis darRveva aqvs, Tu is ar aris dakavSirebuli smenis darRvevasTan, autizm-Tan, gonebriv CamorCenilobasTan, neiromotorul disfunq-ciasTan, emociur aSlilobasa, Tu deprivaciasTan.

sindromis aRsawerad dReisaTvis gamoiyeneba terminebi `darRveuli metyveleba~ da `dazianebuli metyveleba~. amave dros, gansazRvrisaTvis iyeneben sityvas `ganviTarebis”, rac specifikur etiologiaze miuTiTebs. ICD-10-Si gamoiyeneba termini `metyvelebis ganviTarebis specifikuri darRveva~.

klinicistebi da mkvlevrebi cdiloben am mravalfero-vani darRvevebis klasificirebas. metyvelebis ganviTarebis darRvevebis klasifikacia xdeba etiologiis, metyvelebis funqciebis, neirofsiqologiuri da nevrologiuri profi-lis, lingvisturi profilis, an maTi kombinaciis mixedviT.

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metyvelebis ganviTarebis specifikur darRveva saxezea, Tu aRiniSneba:

�. metyvelebis darRveva (metyvelebis Sesafasebel standartizebul testebSi qronologiur an gone-briv asakze 6-dan �� Tveze dabali maCveneblebi);

�. normaluri smena (zRurblis sazRvrebi �50 da 6000 hercs Soris);

3. normaluri araverbaluri inteleqti (araverbaluri IQ saSualoze � SD-ze dabali ar aris);

ar aRiniSneba:

4. gamoxatuli nevrologiuri niSnebi;

5. daavadebebi, romlebic centraluri nervuli siste-mis dazianebas iwveven;

6. oraluri motoruli stereotipuli da funqciuri anomaliebi;

7. fsiqiatriuli, emociuri da qceviTi aSlilobebi;

8. Zaladobis istoria;

9. metyvelebis SeZenili darRveva.

metyvelebis specifikuri darRvevis gamomwvevi faqtorebi

etiologiuri faqtorebi zustad ar aris garkveuli. mkvlevrebis mier sxvadasxva mizezebi saxeldeba. kerZod, xanmokle smeniTi mexsierebis darRveva (Graham, 1988; Rapin, 1978), smeniTi stimulebis Tanmimdevruli aRqmis darRveva, smeniTi informaciis swrafi gadamuSavebis darRveva (Tallal, 1974), ierarqiuli dagegmvis darRveva, gramatikuli darR-vevebi, metyvelebis fonologiuri mxaris darRveva an maTi kombinacia. mniSvnelovani problemaa imis gansazRvra, Tu ra aris lingvisturi deficitis mizezi, bavSvis metyvele-bis romelime komponentis specifikuri deficiti, Tu raime ufro zogadi faqtori. mag. arsebobs monacemebi, romle-bic mowmoben, rom metyvelebis ganviTarebis specifikuri

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darRvevebis mqone bavSvebs mSoblebi janmrTel bavSvebTan SedarebiT gansxvavebulad elaparakebian, Tumca bundo-vania, ra ris Sedegia: metyvelebis specifikuri darRveva iwvevs mSoblebis metyvelebis gansxvavebul stils, Tu pi-riqiT. mSoblebi SeiZleba imitom esaubrebian aseT bavSvs gansxvavebulad, rom moaxdinon misi metyvelebis proble-mebis kompensacia. aseve, Tumca garkveuli kavSiri arsebobs Sua yuris anTebasa da metyvelebis ganviTarebis Seferxebas Soris, kvlevebis mixedviT metyvelebis problemebi qreba yurTan dakavSirebuli smenis problemebis mogvarebasTan erTad. Tallal, Piercy (1973, 1974) metyvelebis specifikuri darRvevis mizezad smeniTi informaciis swrafad gadamuSa-vebisa da fonemebis garCevis siZneles miiCneven. aseTi ba-vSvebis araverbaluri unarebi maTi asakis Sesaferisad aris ganviTarebuli.

nervuli safuZvlebi. metyvelebis specifikuri darR-vevebis nervuli safuZveli zustad garkveuli ar aris. Tanamedrove neirovizualuri gamokvlevebiT aRmoCnda, rom aseT bavSvebs aqvT perisilvianuri qerqis ubnebis bi-lateraluri dazianeba. kompiuterul tomografiulma da magnitur rezonansulma gamokvlevebma gamoavlines, rom am bavSvebis marcxena da marjvena safeTqlis wilebis zeda-piri simetriulia, maSin roca normaSi is asimetriulia. amave dros, metyvelebis darRvevebis mqone bavSvebis 56%-s normaluri kompiuterul tomografiuli maCveneblebi hqondaT (Caparulo, Pothman,1981). diqoturi mosmenis cdeb-Si da smeniTi gamowveuli potencialebis eqsperimenteb-Si gamovlinda, rom metyvelebis specifikuri darRvevis mqone zogierT bavSvs metyvelebis Secvlili funqciuri asimetria aqvs. fotonur emisiuri kompiuteruli tomo-grafiis monacemebiT, normisagan gansxvavebiT eqspresiuli metyvelebis izolirebuli darRvevis mqone zogierT bavS-vTan adgili aqvs marcxena hemisferos Sublis qveda mida-moSi qerqis hiperfuzias (brokas aris CaTvliT), zogierTs Sereuli eqspresiul-impresiuli metyvelebis darRveviT aqvs marcxena Txem-safeTqlis ubnis qerqisa da marjvena Sublis zeda da Sua ubnebis hiperfuzia.

cnobilia, rom metyvelebis specifikuri darRvevebis

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mqone bavSvebis 40%-s aqvs eeg-anomalia, magram umravle-sobis eeg normis farglebSia. klasikuri nevrologiuri gamokvlevebis safuZvelze am jgufis bavSvebs aReniSnebaT motoruli anomaliebis ufro maRali sixSire, vidre smena-daqveiTebul bavSvebs; amave dros, metyvelebis darRvevebis mqone bavSvebis 3�%-s ar gaaCnia ioli nevrologiuri niSne-bic ki.

zemoaRniSnulidan gamomdinare, bavSvTa metyvelebis darRvevebSi yuradReba gadaitanes nevrologiuri maxasia-Teblebidan sindromis fsiqologiur aspeqtebze. Taname-drove midgoma eyrdnoba metyvelebis ganviTarebis darRve-vebis neirofsiqologiur maxasiaTeblebs.

genetikuri safuZvlebi. �� yvelaze cnobili epidemio-logiuri gamokvleva, romelic swavlobda ojaxuri me-mkvidreobis rols metyvelebis specifikur darRvevaSi, amtkicebs, rom aseTi bavSvebis 30%-70%-s aReniSnebaT me-tyvelebis darRvevebis dadebiTi ojaxuri istoria, sakon-trolo jgufTan SedarebiT (��%-46%). kvlevebis Sedegebi mowmoben, rom garemos Zalian mcire gavlena aqvs, an saer-Tod ar axdens zegavlenas normaluri ganviTarebis mqone bavSvis mier enis aTvisebaze. monozigoturi da dizigo-turi tyupebis SedarebiTi kvlevis mixedviT, metyvelebis darRvevebis Tanxvedris albaToba monozigotur tyupebSi mniSvnelovnad maRalia (5�-84%), vidre dizigotur tyu-pebSi (�0-34%). kvlevebis Tanaxmad, genetikuri faqtorebi garkveul rols TamaSoben weriTi da zepiri metyvelebis darRvevebis aRmocenebaSi. genetikuri kvlevebis Sedegebi mowmobs, rom metyvelebis ganviTarebis darRvevebs mka-crad gansazRvruli genetikuri komponenti aqvT. metyve-lebis specifikuri darRveva SeiZleba genetikurad hete-rogenuli darRveva iyos. metyvelebis specifikuri darRvevebis prognozi

longituduri kvlevebis mixedviT skolamdel asakSi ga-movlenili metyvelebis ganviTarebis specifikuri darRve-vebi bavSvebis 40-60%-s SemdgomSic aReniSnebaT. bavSvebis 40%-s, romelTac metyvelebis darRveva daudgindaT 3 wlis asakSi, igive darRvevebi 5 wlis asakSic gamouvlindaT, xolo

�0�

5 wlis asakSi metyvelebis darRvevebis mqone bavSvebis 3�%-s igive problemebi aqvT 7 wlis asakSic (Silva, 1988).

metyvelebis specifikur darRvevebTan SedarebiT metyvelebis zogadi darRvevebi ufro mdgradia da Semd-gomSic grZeldeba. metyvelebis darRvevis mqone 7 wlis bav-Svebis 5�%-s �6 wlis asakSic aqvT metyvelebis rezidualu-ri problemebi.

mniSvnelovani sakiTxia, Tu ramdenadaa SesaZlebeli ba-vSvis metyvelebis problemebis daZlevis winaswarmetyvele-ba. 4 wlis bavSvebSi, romlebic metyvelebis Terapiaze da-diodnen, 90%-mde sizustiT SeiZleboda bavSvis metyvele-bis ganviTarebis donis prognozireba �8 wlis asakisaTvis (Bishop, Edmundson, 1987). longituduri kvlevebis mixedviT, fonologiuri problemebi naklebad mZime da mdgradia se-mantikur da sintaqsur problemebTan SedarebiT. is faqti, rom metyvelebis zogadi darRvevebis koreqcia ufro rTu-lia, vidre specifikuri darRvevebisa, vrceldeba ara marto metyvelebis funqciebze, aramed sxva kognitur unarebzec. maRali araverbaluri inteleqti uaxloesi �0 wlis manZil-ze metyvelebis problemebis daZlevis kargi prediqtoria (Adam, 1984).

metyvelebis pirveladi darRvevebi sxva problemeb-sac iwveven, romlebic metyvelebis darRvevis simptomebis gaqrobis Semdegac ki SeiZleba gamovlindes. amitomaa mniSv-nelovani bavSvis sxva SemecnebiTi funqciebisa da emociuri sferos Seswavlac.

kiTxvis problemebis prognozi. bavSvebs, visac winasasko-lo asakSi metyvelebis darRveva hqondaT, bevrad ufro uZ-neldebaT kiTxvis aTviseba, vidre im bavSvebs, romelTac metyvelebis darRvevebi ar aReniSnebodaT (Silva, 1981; Bishop, Adams, 1990). �0 wliani longituduri kvlevebis Tanaxmad, winasaskolo asakis im bavSvebis 90%-s, visac metyvelebis darRvevebi hqondaT, skolaSi gauWirdaT akademiuri Cveve-bis aTviseba. disleqsiis mqone bavSvebis nawils skolamdel periodSi aReniSnebodaT fonologiuri problemebi, eqspre-siuli da impresiuli leqsikonis siRaribe, sintaqsis gage-bisa da formulirebis problemebi.

inteleqtis prognozi. metyvelebis darRvevis mqone ba-

�0�

vSvebs SemdgomSi dabali IQ maCveneblebis didi albaToba aqvT. bavSvebs, romelTac 3 wlis asakSi metyvelebis darR-vevebi hqondaT 7 da 9 wlis asakSi normasTan SedarebiT dabali IQ maCveneblebi aReniSnebodaT. es umetesad exeba verbalur IQ-s, naklebad araverbalur IQ-s, Tumca samive IQ maCvenebeli daqveiTebulia.

socialur-emociuri da qceviTi problemebis progno-zi. metyvelebis darRvevebis mqone bavSvebs aqvT am pro-blemebis aRmocenebis didi riski. literaturaSi cnobilia socialur-emociuri da qceviTi problemebis farTo wre - socialuri urTierTobebis Camoyalibebisa da SenarCu-nebis sirTule, maRali SfoTva, yuradRebis deficiti, an-tisocialuri, agresiuli qceva, urCoba. aseTi problemebi xSiria bavSvebSi, visac metyvelebis zogadi darRvevebi da gagebis darRveva aqvT, eqspresiuli metyvelebis darRvevis mqone bavSvebTan SedarebiT. SfoTva, yuradRebis da socia-luri urTierTobebis problemebi izrdeba metyvelebis spe-cifikuri darRvevis mqone bavSvis asakis matebasTan erTad (Cantwell,1989; Rutter, 1991).

amrigad, bavSvebi, romelTac metyvelebis darRveve-bi skolamdel asakSi aqvT mowyvladi jgufia; amave dros, praqtika gviCvenebs, rom bavSvebis �/3-s, visac skolamdel periodSi metyvelebis darRvevebi hqonda, SemdgomSi aRar aqvT raime problema metyvelebaSi.

Sefasebisa da intervenciis midgomebi ufro farTo spe-qtris da moqnili unda iyos, raTa moicavdes inteleqtua-lur, socialur-emociur da qceviT problemebs da ar unda iyos fokusirebuli viwrod metyvelebis darRvevebze.

�03

eqspresiuli metyvelebis darRveva

eqspresiuli metyvelebis darRveva ganviTarebis spe-cifikuri darRvevaa, romlis drosac bavSvis eqspresiuli metyvelebis gamoyenebis unari mis gonebriv asakTan Seda-rebiT dabalia. aRsaniSnavia, rom mimarTuli metyvelebis gageba normis farglebSia. zogierT SemTxvevaSi (Tumca ara yovelTvis) aRiniSneba artikulaciis darRvevebi.

eqspresiuli metyvelebis darRvevis diagnostikuri krite-riumebi ICD-10-is mixedviT

miuxedavad imisa, rom bavSvis metyvelebiTi ganviTare-ba Cveulebriv mniSvnelovani individualuri Taviseburebe-biT xasiaTdeba, Tu bavSvi � wlis asakSi ar ambobs calkeul sityvebs (an maT msgavs metyvelebiT warmonaqmnebs), xolo 3 wlis asakSi ver adgens or sityvian martiv frazebs – amgvari mdgomareoba unda Sefasdes rogorc metyvelebis ganviTarebis mniSvnelovani Seferxeba. Semdgomi darRvevebi moicaven: sityvieri maragis simwires, sityvaTa garkveuli nakrebis gadaWarbebul gamoyenebas, Sesabamisi sityvebis SerCevis sirTuleebs, Semoklebuli frazebis gamoyenebas, winadadebis araswor struqturas: sintaqsur Secdomebs (gansakuTrebiT daboloebebisa da winsarTebis gamotoveba), iseTi gramatikuli formebis araswori gamoyenebas an gamo-tovebas, rogoricaa windebulebi, nacvalsaxelebi. agreTve problemuria zmnebis uRleba, an arsebiTi saxelebis brunva. SeiZleba aRiniSnebodes wesebis araswori, an gadametebulad ganzogadebuli gamoyeneba. agreTve, SeiZleba aRiniSnebodes metyvelebis moqnilobis darRveva da warsuli gamocdile-bis moyolisas movlenaTa Tanmimdevrobis aRdgenis sirTu-leebi.

eqspresiuli metyvelebis darRvevas xSirad axlavs ar-tikulaciis darRvevebi.

es diagnozi SeiZleba daisvas mxolod im SemTxvevebSi, roca eqspresiuli metyvelebis ganviTarebis Seferxeba cde-ba bavSvis gonebrivi ganviTarebis asakis Sesabamis normalu-ri variaciis farglebs. amasTanave, receptuli metyvelebis unarebi normis farglebSia (Tumca, xSirad isini saSualo

�04

doneze dablaa). araverbaluri mimaniSneblebis (rogoricaa Rimili, an Jestebi) da `Sinagani metyvelebis~ (rac aisaxeba fantaziebsa da rolur TamaSebSi) gamoyeneba sityvebis ga-reSe socialuri urTierTobis unarTan erTad SedarebiT Senaxulia.

metyvelebis problemebis miuxedavad, bavSvs unda ur-TierToba da sityvebis naklebobis kompensacias cdilobs Jestebis, mimikis, an arametyvelebiTi vokalizaciebis ga-moyenebiT. amisda miuxedavad xSirad, gansakuTrebiT sko-lamdeli asakis bavSvebTan, aRmocendeba Tanmdevi darRveve-bi, romlebic moicavs: problemebs TanatolebTan urTier-Tobisas, emociur da qceviT darRvevebs da/an gadaWarbebul aqtiurobasa da uyuradRebobas. SemTxvevaTa umniSvnelo raodenobaSi aRiniSneba smenis nawilobrivi (xSirad SerCe-viTi) daqveiTeba, magram misi simZime ar unda iyos sakmari-si metyvelebis ganviTarebis Seferxebis aRmocenebisaTvis. sasaubro metyvelebis darRveva TvalSisacemia adreuli bavSvobidan. Tumca xandaxan anamnezSi aRiniSneba ramdeni-me pirveli sityvis aSkarad swori gamoyeneba, SemdgomSi ki metyvelebis ganviTareba neldeba.

unda gamoiricxos: • afazia epilefsiiT (landau-klefneris sindromi) (F80.3);

•receptuli metyvelebis ganviTarebasTan dakavSirebuli disfazia an afazia (F80.�);

•disfazia an afazia (araklasificirebuli) (R 47.0);

• eleqtiuri mutizmi (F 94.0);

• gonebrivi CamorCeniloba (F70-F79);

• ganviTarebis zogadi darRvevebi (F84 -).

eqspresiuli metyvelebis darRvevis diagnostikuri kriteriumebi DSM-IV-TR-is mixedviT

A. eqspresiuli metyvelebis Sesafasebel standartul tes-tebSi miRebuli qula mniSvnelovnad dabalia araverba-

�05

luri inteleqtis Sesafasebel standartizebul teste-bSi miRebul qulasTan SedarebiT.

B. A-Si gamovlenili darRveva dakavSirebulia akademiur miRwevebTan, an yoveldRiuri cxovrebis aqtivobebTan, romlebic metyvelebis gamoyenebas gulisxmobs. es mZime SemTxvevebSi vlindeba SezRudul leqsikonSi, martivi winadadebebis, mxolod awmyos konstruqciebis gamoyene-baSi. iol SemTxvevebSi SeiZleba adgili hqondes merye-obasa da Secdomebs sityvebis gaxsenebaSi, grZeli da rTuli winadadebebis formulirebaSi.

C. ar aris dakavSirebuli ganviTarebis pervesiul aSli-lobasTan, metyvelebis darRveva ar unda iyos Sereuli receptul-eqspresiuli darRveva.

D. Tu adgili aqvs gonebriv CamorCenilobas, metyvelebis motorul an sensorul deficits, an garemos mxridan deprivacias, metyvelebis sirTuleebi, rogorc wesi, dakavSirebulia am problemebTan.

SeniSvna: Tu adgili aqvs metyvelebis motorul an senso-rul deficits, an nevrologiur mdgomareobas, unda gada-xvideT III RerZze.

gavrcelebaDSM-IV-is mixedviT 3 wlamde bavSvebSi metyvelebis darRve-va aRiniSneba bavSvebis TiTqmis �0-�5%-Si, saskolo asakisa-Tvis es maCvenebeli 3-7 %-ia.

rogor davexmaroT eqspresiuli metyvelebis darRvevis mqone bavSvs

• pirvel rigSi unda metyvelebis problemebi unda Sefasdes multidisciplinuri gundis mier, romelSic Sevlen sxva-dasxva specialistebi (fsiqologi, logopedi, nevrolo-gi, pediatri). bavSvis Sesafaseblad gamoiyeneba interviu, dakvirveba, metyvelebis Sesafasebeli standartuli tes-tebi, araverbaluri inteleqtis Sesafasebeli testebi.

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• rac ufro adreul asakSi moxdeba diagnostireba, miT ufro efeqturi iqneba bavSvis problemaze muSaoba.

• adekvaturi diagnostirebis Semdeg aucilebelia Sesaba-misi specialistebis bavSvTan muSaoba. aRsaniSnavia, rom bavSvis problemaze muSaoba xangrZlivi procesia da gr-Zeldeba �-3 weli, SeiZleba metic.

• specialistis paralelurad bavSvis metyvelebaze muSao-bis procesSi aucilebelia mSoblis aqtiuri Tanamonawi-leoba. Zalze mniSvnelovania is, rom bavSvi ar aiZuloT warmoTqvas raime sityva an winadadeba, an sworad gaime-oros sityva, an bgerebi. garSemomyofTa daJinebuli mo-Txovna bavSvs uaryofiT damokidebulebas uyalibebs Tavad metyvelebis procesisadmi, radgan mas gamudmebiT Txoven imis gakeTebas rac mas ar SeuZlia, an uWirs.

o samagierod, bavSvisaTvis aucilebelia sametyvelo mas-timulirebeli garemos Seqmna. kerZod, unda gauxmova-noT yvelaferi (Tqveni moqmedebebi, misi moqmedebebi, rasac xedavs da esmis), am dros Tqveni metyveleba unda iyos mkafio, swori artikulaciiT, winadadebebi unda iyos martivi. mag.: sufras SliT da aWmevT, moqmedebis paralelurad ambobT: ̀ ai kovzi, supi, Wiqa davde, ai dana, tafidan gadmoviReT katleti”; an mag.: acmevT, parale-lurad eubnebiT: `momeci xeli, ai Sarvali, ai perangi, gamoswie fexi”. seirnobT quCaSi da eubnebiT, mag.: `naxe Citi, gogo midis, manqana modis, biWi dgas, ai xe da a.S.” aseTi aqtiuri metyvelebiTi stimulacia xels Seuwyobs bavSvis mier uneblie doneze sityvebis warmoTqmas; igi uneblied iwyebs imis warmoTqmas, risi Tqmac mas nebis-mierad ar SeeZlo. gaxmovanebis dros gansakuTrebuli yuradReba miaqcieT antonimebis dasaxelebas (mag: `kur-dRels mokle kudi aqvs, melias grZeli~, `es saxli maRa-lia, es dabali~ da a.S.), raodenobas (mag: ̀ naxe 3 kartofi-li aviRe; erTi, ori, sami~ da a.S.), sagnebis daniSnulebis axsnas (mag: `saaTi gvWirdeba, rom gvaCvenos dro~, `tafa gvWirdeba, rom raime SevwvaT~ da a.S).

o imRereT misi sayvareli melodiebi erTad.

�07

o Tu bavSvis eqspresiuli metyvelebis darRveva mZimea, SeiZleba SesTavazoT cxovelebis figurebiT TamaSi: iRebT cxovelebis figurebs da eubnebiT: `ai Zroxa. rogor akeTebs Zroxa? muuu; aba vipovoT ZaRli, ro-gor yefs? au, au, au” da a.S. yovelive amas akeTebT mkveTri, wamRerebuli intonaciiT.

o iTamaSeT sxvadasxvagvari roluri TamaSi (mag: `maRa-ziobana~, `stumrobana~, `mZRolobana~ da a.S.). TamaSis procesSi leqsika da windadadebebis sirTule unda icvalos bavSvis eqspresiuli metyvelebis darRvevis simZimis mixedviT. am TamaSebis dros xdeba martivi sayofacxovrebo situaciebis gaTamaSeba. mag: `maRa-ziobanas~ TamaSis dros SeiZleba Tqven iyoT myidve-li, bavSvi – gamyidveli. Tqven Soris unda warimar-Tos martivi dialogi. Tavidan SeiZleba orive roli (bavSvis da Tqveni) gaaxmovanoT Tqven TviTon; Semdeg rodesac bavSvi gaerkveva, Tu ra tipis TamaSs TxovT da martivi frazebic (mag: myidveli - `ra Rirs bur-Ti?~ gamyidveli - `erTi lari~ da a.S.) nacnobi gaxde-ba, SeiZleba TviTonac gaaxmovanos dialogi. iTamaSeT manam, sanam bavSvi TviTon ar daiwyebs gaxmovanebas (amas SeiZleba dasWirdes 5-jer, an gacilebiT metjer TamaSi). mniSvnelovania Semdegi: erTi da igive kiTxvas erT jerze bevrjer nu gaumeorebT da maSinve pasuxs nu mosTxovT. jer Tqven ekiTxebiT, Tu bavSvi ar pa-suxobs - Tqvenve upasuxebT kiTxvas da agrZelebT mo-qmedebas.

o aarCieT suraTi, romelzec gaSlilia moqmedeba, aRu-wereT bavSvs suraTi da miuTiTeT TiTiT (mag: `naxe, aq Zroxa balaxs Zovs~ da a.S.), TxoveT gipovoT Tqvens mier dasaxelebuli obieqtebi, am obieqtebis nawile-bi. dausviT kiTxvebi (Tavidan daiwyeT mimTiTebeli kiTxvebi, romelic nawilobriv Seicavs pasuxs, mag: `mokrifa bavSvma vaSli?~, Semdeg kiTxvebi gaarTuleT mag: `ras akeTebda bavSvi baRSi?~), Tu ver gipasuxebT, Tqven TviTonve upasuxeT.

o bavSvis metyvelebis ganviTareba mWodrodaa dakav-

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Sirebuli bavSvis natifi motorikis ganviTarebasTan, amitom Zalian mniSvnelovania am mimarTulebiT muSao-bac.

iTamaSeT mozaikiT; Tavidan mozaikis Rilakebi CaarWos cal-cali xeliT. mas Semdeg rac moZraobebi ufro daxvewili gaxdeba (ufro iolad CaarWobs mozaikis Rilakebs, aRebi-sas aRar gauvardeba isini xelidan da a.S.), uTxariT bavS-vs, rom mozaikebis Rilakebi CaarWos orive xeliT erT-droulad;

xateT xelis saRebavebiT: xelis saRebavi wausviT mxolod cerze, bavSvma imave xelis danarCeni TiTebiT aiRos es saRebavi da ise daxatos (gaakeTeT orive xelze);

ZerweT plasteliniT sxvadasxva obieqtebi, Tavidan martivi mag: burTi, gveli, Semdeg ki ufro rTuli;

receptuli metyvelebis darRveva

receptuli metyvelebis darRveva ganviTarebis specifikuri darRvevaa, romlis drosac mimarTuli metyvelebis gagebis unari CamorCeba bavSvis gonebriv asaks. TiTqmis yvela Sem-TxvevaSi eqspresiuli metyvelebac darRveulia. xSirad aRiniSneba sityvebisa da bgerebis warmoTqmis defeqtebi.

receptuli metyvelebis darRvevis diagnostikuri kri-teriumebi ICD-10-is mixedviT

im SemTxvevaSi, Tu bavSvi �8 Tvis asakSi ar reagirebs nac-nob ramdenime saganze, � wlis asakSi ki ar asrulebs martiv sayofacxovrebo instruqciebs, saxezea metyvelebis ganvi-Tarebis Seferxebis arsebiTi niSnebi. Semdgomi darRvevebi moicaven: gramatikuli struqturebis (uaryofa, SekiTxva, Sedareba da a.S.) gagebis uunarobas, metyvelebis sxvadasxva aspeqtebis (mag: xmis toni) gagebis sirTuleebs.

es diagnozi SeiZleba daisvas mxolod im SemTxvevebSi,

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rodesac receptuli metyvelebis ganviTarebis Seferxebis simZime cdeba bavSvis gonebrivi ganviTarebis asakis Sesa-bamis normaluri variaciis farglebs, da im SemTxvevaSi, Tu darRveva ar akmayofilebs ganviTarebis zogadi dar-Rvevis kriteriums. TiTqmis yvela SemTxvevaSi eqspresiuli metyvelebis ganviTarebac mniSvnelovnad ferxdeba, xSirad aRiniSneba sityvebisa da bgerebis warmoTqmis problemebi. receptuli metyvelebis darRvevas TiTqmis yovelTvis Tan axlavs socialuri, emociuri da qceviTi darRvevebi. xSiria hiperqtivoba da uyuradReboba, socialuri Seuguebloba da Tanatolebisagan izolacia, SfoTva, an zedmeti simorcxve. receptuli metyvelebis darRvevis ufro mZime formebis mqone bavSvebi SeiZleba Zalian CamorCnen socialur ganvi-TarebaSi, SesaZlebelia bavSvs SeeZlos mibaZviT metyvele-ba (am dros ar esmis warmoTqmulis azri) da interesebis wris SezRudva. Tumca isini gansxvavdebian autizmis mqone bavSvebisagan imiT, rom SeuZliaT socialuri urTierTo-ba, TanatolebTan rolur TamaSebs TamaSoben, aqvT adek-vaturi damokidebuleba mSoblebTan (mag: maT nugeSisaTvis mimarTaven, rodesac raime uWirT), iyeneben Jestebs da aqvT araverbaluri urTierTobis umniSvnelo darRvevebi. xSir-ad aRiniSneba maRali tonebisadmi smeniTi mgrZnobelobis daqveiTeba, magram misi simZime ar unda iyos sakmarisi me-tyvelebis ganviTarebis Seferxebis aRmocenebisaTvis.

metyvelebis ganviTarebis pirveladi darRvevebi gavle-nas axdens bavSvis sxva fsiqikuri funqciebis ganviTarebazec. swavlis problemebi (kerZod wera-kiTxvis aTviseba) xSirad ukavSirdeba metyvelebis deficits. aseT bavSvebSi xSiria yuradRebis deficitisa da hiperaqtivobis sindromi. maT xSirad aqvT qceviTi da emociuri problemebi. metyvelebis ganviTarebis darRveva SeiZleba iwvevdes inteleqtis gan-viTarebis deficits, radganac swored metyvelebiTaa ga-Sualebuli simboluri funqciebis ganviTareba adreul saskolo asakSi. amave dros SesaZlebelia, rom metyvelebis darRvevebi gamowveuli iyos kognituri unarebis ioli deficitiT.

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unda gamoiricxos:

• afazia epilefsiiT (landau-klefneris sindromi) (F80.3);

• autizmi (F84.0,F84.1);

•disfazia an afazia (araklasificirebuli) (R 47.0);

• eqspresiuli metyvelebis ganviTarebasTan dakavSirebuli disfazia an afazia (F80.�);

• eleqtiuri mutizmi (F 94.0);

• gonebrivi CamorCeniloba (F70-F79);

• siyruis Sedegad metyvelebis ganviTarebis Sefrxeba (H90- H91).

receptul-eqspresiuli metyvelebis Sereuli darRvevis (ICD-10-is mixedviT receptuli metyvelebis darRvevis) diag-nostikuri kriteriumebi DSM-IV-is mixedviT

A. receptuli metyvelebis Sesafasebel standartizebul testSi miRebuli qula mniSvnelovnad dabalia araverba-luri inteleqtis Sesafasebel standartizebul testSi miRebul qulasTan SedarebiT.

B. A-Si gamovlenili darRveva zegavlenas axdens akade-miur miRwevebsa, an yoveldRiuri cxovrebis aqtivobe-bze, romlebic moiTxoven receptul metyvelebas. mZime SemTxvevebSi es vlindeba martivi sityvebisa da winada-debebis gagebis darRvevaSi. iol SemTxvevebSi SeiZleba adgili hqondes garkveuli tipis sityvebis, specialuri terminebis gagebis gaZnelebas, an rTuli winadadebis ga-gebis gaZnelebas.

C. ar aris dakavSirebuli ganviTarebis pervesiul aSlilo-basTan.

D. Tu adgili aqvs gonebriv CamorCenilobas, metyvelebis motorul an sensorul deficits, an garemos depriva-cias, metyvelebis sirTuleebi, rogorc wesi, dakavSire-bulia am problemebTan.

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SeniSvna: Tu adgili aqvs metyvelebis motorul an senso-rul deficits, an nevrologiur mdgomareobas, unda ga-moiyenoT III RerZi.

gavrcelebaDSM-IV-is mixedviT skolamdeli asakis bavSvebSi receptuli metyvelebis darRveva aRiniSneba bavSvebis TiTqmis 5%-Si; saskolo asakisaTvis es maCvenebeli 3%-ia.

rogor davexmaroT receptuli metyvelebis darRvevis mqone bavSvs

• pirvel rigSi unda Sefasdes metyvelebis problemebi multidisciplinuri gundis mier, romelSic Sevlen sxva-dasxva dargis specialistebi (fsiqologi, logopedi, ne-vrologi, pediatri).

• rac ufro adreul asakSi moxdeba swori diagnostireba, miT ufro efeqturi iqneba bavSvis problemaze muSaoba.

• adekvaturi diagnostirebis Semdeg aucilebelia Sesaba-misi specialistebis bavSvTan muSaoba. aRsaniSnavia, rom bavSvis problemaze muSaoba xangrZlivi procesia (xangr-Zlivoba �-3 weli, SeiZleba metic).

• specialistis muSaobis paralelurad aucilebelia mSo-blis aqtiuri Tanamonawileoba bavSvis metyvelebaze muSa-obis procesSi. Zalze mniSvnelovania is, rom bavSvi ar vai-ZuloT warmoTqvas raime sityva an winadadeba, an sworad gaimeoros sityva, an bgerebi. garSemomyofTa daJinebuli moTxovna bavSvs uaryofiT damokidebulebas uyalibebs Ta-vad metyvelebis procesisadmi, radgan mas gamudmebiT Txo-ven imis gakeTebas, rac mas ar SeuZlia, an uWirs.

o bavSvs elaparakeT enis moCleqvis gareSe, swori gamo-TqmiT.

o bavSvs unda hqondes kargad struqturirebuli dRis reJimi: kvebisa da Zilis dro ar unda icvlebodes. da-Zinebis rituali unda iyos yovelTvis msgavsi.

o aucilebelia deda eTamaSos bavSvs yoveldRe naxevari

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saaTi. es metad mniSvnelovania bavSvis emociuri sfe-ros normaluri ganviTarebisaTvis, misi komfortisa da usafrTxoebis SegrZnebisaTvis; am fonze metyvele-bis ganviTarebis stimulacia bevrad ufro efeqturad moxdeba.

o pirvel rigSi mniSvnelovania bavSvma iswavlos mimar-Tul metyvelebaze yuradRebis gamaxvileba. amisa-Tvis saWiroa intonirebuli metyveleba _ wamRerebiT. bavSvs unda elaparakoT erT sityviani winadadebiT da mkafio intonaciiT, gansxvavebul sityvebs gansa-xvavebuli intonaciiT an wamRerebiT gamoTqvamT. es aucilebelia, radgan bavSvisTvis sityvis musikaluri intonacia ufro informatulia, vidre bgeriTi. mag. wadi, modi, adeqi, waiRe, moitane – am sityvebs yvelas unda hqondes gansxvavebuli intonacia, romliTac ba-vSvi maT gamoadiferencirebs.

o bavSvisaTvis aucilebelia sametyvelo mastimulirebe-li garemos Seqmna. kerZod, ufrosi axmovanebs yvela Tavis moqmedebas bavSvTan yofnisas � sityviani fra-zebiT. aseTi aqtiuri metyvelebiTi stimulacia xels Seuwyobs bavSvis mier uneblie doneze sityvebis war-moTqmas.

o igive mizans emsaxureba cxovelebiT TamaSi: iRebT cxovelebis figurebs da eubnebiT: `ai kata. rogor knavis kata? miauu~; `aba vipovoT Txa, rogor akeTebs Txa? be, be, be” da a.S. yovelive amas akeTebT mkveTri, wamRerebuli intonaciiT.

o iTamaSeT kubikebiT, aaSeneT koSki da mere daangrieT, Tan gaaxmovaneT _ bax, bux.

o Zalze mniSvnelovania, moxdes bavSvis sxvadasxva sen-soruli arxebis stimulacia Sesabamisi gamRiziane-blebiT.

o metyvelebis ganviTareba mWidrodaa dakavSirebuli bavSvis natifi motorikis ganviTarebasTan, amitom Za-lian mniSvnelovania am mimarTulebiT muSaobac.

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iTamaSeT mozaikiT; xateT xelis saRebavebiT: xelis saRebavi wausviT mxolod

cerze, bavSvma imave xelis danarCeni TiTebiT aiRos es saRebavi da ise daxatos (gaakeTeT orive xelze);

ZerweT plasteliniT sxvadasxva obieqtebi, Tavidan martivi, mag: burTi, gveli, Semdeg ki ufro rTuli.

metyvelebis artikulaciis specifikuri darRveva

metyvelebis artikulaciis specifikuri darRveva ganviTa-rebis specifikuri darRvevaa, romlis drosac metyvelebi-Ti bgerebis warmoTqmis dauflebis unari CamorCeba bavSvis gonebrivi asakis Sesabamis dones. amasTanave, metyvelebis sxva unarebis ganviTarebis done asakis Sesabamisia.

artikulaciis specifikuri darRvevis diagnostikuri kriteriumebi ICD-10-is mixedviT

bgeraTwarmoTqmis unaris dauflebis asaki da is Tanmi-mdevroba, ra TanmimdevrobiTac swavlobs bavSvi calkeuli bgerebis warmoTqmas Zalian cvalebadobs.

normaluri ganviTareba. 4 wlis asakSi bavSvebs xSirad aqvT bgeraTwarmoTqmis problemebi, magram maTi metyveleba gasagebia garSemomyofTaTvis. metyvelebiTi bgerebis umra-vlesobis daufleba xdeba 6-7 wlis asakisaTvis, Tumca Sesa-Zloa calkeuli bgerebis kombinaciis warmoTqma jer kidev problematuri iyos, magram es ar unda iwvevdes urTierTo-bis problemebs. ��-�� wlis asakisaTvis bavSvs unda SeeZlos yvela sametyvelo bgeris sworad warmoTqma.

ganviTarebis darRvevaze eWvi Cndeba maSin, roca bavS-vis mier bgerebis daufleba igvianebs, da/an cdeba normis farglebs, rac iwvevs araswor bgeraTwarmoTqmas da gar-SemomyofTaTvis metyveleba gaugebari an Znelad gasagebi xdeba: adgili aqvs bgerebis gamotovebas an Canacvlebas, agreTve, bgeraTSeTanxmebis warmoTqmis cvlilebebs (anu, zogierT sityvebSi bavSvi fonemebs sworad warmoTqvams, sxva sityvebSi ki ver axerxebs swor gamoTqmas).

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es diagnozi SeiZleba daisvas mxolod Semdeg SemTxve-vebSi: �) artikulaciis darRvevis simZime cdeba bavSvis gonebrivi ganviTarebis asakis normaluri variaciis far-glebs, �) araverbaluri inteleqti normis farglebSia, 3) artikulaciis darRvevebi uSualod ar aris ganpirobebu-li sensoruli, anatomiuri an nevrologiuri anomaliebiT, 4) eqspresiuli da receptuli metyvelebis unari normis farglebSia, 5) bgeraTwarmoTqma namdvilad darRveulia im subkulturis metyvelebis gaTvaliswinebiT, romelsac miekuTvneba bavSvi.

unda gamoiricxos:

• artikulaciis darRveva Semdegi mdgomareobebis SemTx-vevaSi:

oafazia (araklasificirebuli) (R 47.0);

oapraqsia (R 48.�);

• artikulaciis darRvevebi, romelic Tan axlavs me-tyvelebis ganviTarebis Semdeg darRvevebs:

oeqspresiuli metyvelebis ganviTarebasTan dakavSire-buli disfazia an afazia (F80.�);

oreceptuli metyvelebis ganviTarebasTan dakavSirebu-li disfazia an afazia (F80.�);

osasis gaxleCva an piris Rrus sxva anatomiuri anoma-liebi (Q35-Q38);

osmenis dakargva (H90-H91);

ogonebrivi CamorCeniloba (F70-F79).

fonologiuri darRvevebis (ICD-10-is mixedviT artikula-ciis specifikuri darRvevis) diagnostikuri kriteriumebi DSM-IV-TR-is mixedviT

A. ganviTarebis Sesabamisi metyvelebiTi bgerebis gamoye-nebis sirTuleebi (mag: Secdomebi bgerebis warmoTqmisas, gamoyenebisas, interpretaciisas, an organizaciisas. Sec-

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domebi ar SemoisazRvreba erTi bgeris meoreTi Canacv-lebiT, an bgerebis gamotovebiT).

B. metyvelebiTi bgerebis warmoTqmis darRveva dakavSire-bulia akademiur miRwevebTan, yoveldRiuri cxovrebis aqtivobebTan, an socialur komunikaciasTan.

C. Tu adgili aqvs gonebriv CamorCenilobas, metyvelebis motorul an sensorul deficits, an garemos depriva-cias, metyvelebis sirTuleebi, rogorc wesi, dakavSire-bulia am problemebTan.

SeniSvna: Tu adgili aqvs metyvelebis motorul an senso-rul deficits, an nevrologiur mdgomareobas, unda gamoiyenoT III RerZi.

gavrcelebaDSM-IV-is monacemebis mixedviT 6-7 wlis asakis bavSvebis

daaxloebiT �%-s aReniSnebaT zomieri an mZime xarisxis fonologiuri darRvevebi, ufro msubuqi darRvevebi ki gacilebiT xSiria. �7 wlisaTvis gavrceleba iklebs 0,5 %-mde.

metyvelebis SeZenili darRvevebi bavSvebSi

ra aris bavSvTa metyvelebis SeZenili darRveva?

bavSvTa metyvelebis SeZenili darRveva _ afazia, Tavis tvinis dazianebis Semdgom aRmocenebuli, ukve ganviTare-buli metyvelebis darRvevaa.

�980 wlamde warmoebul kvlevebSi xazgasmuli iyo ufrosebisa da bavSvTa afaziebs Soris gansxvaveba. bavSvTa afazias axasiaTebdnen negatiuri niSnebiT _ bavSvebSi ZiriTa-di aqcenti keTdeboda im simptomebze, romlebic ar axasi-aTebda mozrdilTa klasikur afazias, e.i. mozrdilTa afazia Sesadarebeli etaloni iyo. adreuli Sexedulebis mixedviT, bavSvTa afazia xasiaTdeba eqspresiuli metyvelebis gardama-

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vali defeqtebiT, rac aRmocendeba difuzuri, Tavis tvinis naklebad lateralizebuli nervuli meqanizmebis darRvevis safuZvelze. am TvalsazrisiT, bavSvTa da mozrdilTa afazia erTmaneTisagan gansxvavdeba metyvelebis darRvevis simptome-biT, metyvelebis aRdgenis tempiT, dazianebis lokalizaciiTa da lateralizaciiT. am gansxvavebas mniSvnelovnad ganapiro-bebs asakobrivi sxvaoba.

�980 wlis Semdgom Zveli warmodgenebi bavSvTa afazi-aze mniSvnelovnad Seicvala, rac ganapiroba neirovizual-uri kvlevis teqnikis daxvewam da metyvelebis ganviTarebis Sesafasebeli adekvaturi standartuli instrumentebis ra-odenobis gazrdam. Zveli SexedulebiT, bavSvebs, mozrdil-ebTan SedarebiT, asakobrivi upiratesoba gaaCniaT. amJamad cnobilia, rom es upiratesoba (Tu aseTi ram arsebobs) Za-lze xanmoklea da mwvave afaziuri simptomebis Semcirebas-Tanaa dakavSirebuli. bavSvebsa da mozrdilebs Tavis tvinis dazianebis mwvave periodSi erTnairi afaziuri simptomebi aqvT. aseT dros afaziis gamosavalisTvis asaks naklebad aqvs prognostuli mniSvneloba. amave dros, mozrdilebisa-gan gansxvavebiT, bavSvebs ufro swrafad uqrebaT afaziis simptomebi, Tumca, metyvelebis funqcia, SeiZleba, Tana-tolebTan SedarebiT, mniSvnelovnad hqondeT daqveiTebu-li xangrZlivi periodis ganmavlobaSi.

ra simptomebiT xasiaTdeba bavSvTa afazia?

bavSvTa afazias istoriulad axasiaTebdnen eqspre-siuli metyvelebis moSliT, Raribi da mouqneli spontanu-ri metyvelebiT, problemebiT sintaqsSi, telegrafuli me-tyvelebiT, sityvis moZebnis sirTuleebiT. bavSvTa afaziis eqspresiuli xasiaTis Sesaxeb tradiciuli Sexedulebis sa-fuZvels warmoadgenda is faqti, rom bavSvebSi aRwerili ar iyo receptuli metyvelebis darRvevisaTvis damaxasaiTebe-li simptomebi (logorea, verbaluri stereotipebi, Jargoni). miuxedavad imisa, rom ukanaskneli periodis gamokvlevebma bavSvebSic daadastura sensoruli afaziisaTvis damaxasia-Tebeli fonetikuri Jargonis, parafaziebis, neologizmebi-

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sa da gagebis deficitis arsebobis xSiri SemTxvevebi, igi amJamadac, upiratesad, eqspresiuli metyvelebis darRveva-daa miCneuli. aRmoCnda, rom bavSvTa afaziuri simptomebi bevrad mravalferovania, vidre es adre iyo aRwerili; Se-sabamisad, mozrdilebisaTvis damaxasiaTebeli afaziis simp-tomebi sxvadasxva sixSiriT bavSvebSic gvxvdeba. magaliTad, �957 wels bavSvebSi aRwerili landau-klefneris sindromi, romelic xasiaTdeboda metyvelebis gamoxatuli da xangr-Zlivi akustikur-gnostikuri darRveviT; marcxena Sua ar-teriis anevrizmis arsebobis dros ki aRweril iqna gagebis iseTive deficiti, rogoric mozrdilTa sensoruli afa-ziisTvisaa damaxasiaTebeli.

bavSvebSi metyvelebis aRdgenis tempi swrafia, Tumca, �5-50%-Si simptomebi erTi wlis Semdegac rCeba. darRveuli metyvelebis aRdgenis xangrZlivi gamokvlevebis safuZvel-ze dadgenilia, rom metyvelebis pragmatuli funqcia Sei-Zleba daqveiTebuli iyos afaziis simptomebis Sesustebisa da gaqrobis SemTxvevaSic; saskolo asakis bavSvebSi, afaziu-ri simptomebis gaqrobis miuxedavad, akademiuri moswreba daqveiTebulia, masalis aTviseba kidev ufro rTuldeba ma-Ral klasebSi, radganac izrdeba masalis moculoba da mis asaTviseblad swrafi verbaluri gadamuSavebaa saWiro.

adrindel mosazrebas imis Sesaxeb, rom bavSvTa afa-zia naklebad fokaluria da aRmocendeba tvinis arafoka-luri meqanizmebis safuZvelze, ramdenime mizezi aqvs. pir-vel rigSi, aRsaniSnavia is faqti, rom daskvnebi efuZneba iseTi dakvirvebebis Sedegebs, romelSic jgufebi Sedgeba Tavis tvinis travmuli, an infeqciuri etiologiis, arc-Tu iSviaTad bilateraluri dazianebis mqone bavSvebisagan. Tanamedrove gamokvlevebis mixedviT, afaziis gamomwvev Ta-vis tvinis dazianebebs gansxvavebuli efeqti aqvs bavSvebsa da mozrdilebSi. adreul asakSi ganviTarebul dazianebebs, SeiZleba, ioli fokaluri rezidualuri cvlilebebic da-erTos.

fiqrobdnen, rom adamianis sicocxlis pirveli �0 wlis ganmavlobaSi metyvelebis lateralizacia TandaTanobiT yalibdeba. am Sexedulebis argumentad iSveliebdnen mo-nacemebs, romelTa mixedviTac marjvenamxrivi dazianebe-

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bis dros, mozrdilebTan SedarebiT, bavSvebSi ufro xSiri iyo afaziis SemTxvevebi. ukanaskneli periodis kvlevebis mixedviT marcxena hemisferos dazianebisas afaziis riski erTnairia memarjvene bavSvebsa da mozrdilebSi. bavSvebSi afaziis ukuganviTareba marcxena hemisferos dauzianebe-li areebis integrirebas ufro metad ukavSirdeba, vidre marjvena hemisferos mier metyvelebis funqciebis sakuTar Tavze aRebas.

asaki korelaciaSia afaziis etiologiasTan. kerZod, mozrdilebSi afazia yvelaze xSiria insultebis Semdeg, ma-Sin, roca bavSvebSi yvelaze xSirad gvxvdeba qala-tvinis travmisa da epilefsiis SemTxvevebSi. vinaidan bavSvisa da mozrdilis afazia erTmaneTisagan gansxvavdeba etiologii-sa da asakis mixedviT, aRdgenac gansxvavebuli xasiaTisaa.

ra iwvevs bavSvTa afazias?

• gulyrebi da masTan dakavSirebuli daavadebebi;

• vaskuluri daavadebebi;

• qala-tvinis travma;

• tvinis simsivneebi;

• radio- da qimioTerapia leikemiis dros;

• infeqciebi (virusuli encefalitebi);

• metaboluri daavadebebi.

afazia landau-klefneris sindromis (lks) dros

gansazRvreba:

• lks aris metyvelebis SeZenili darRveva, rodesac bavS-vebSi asakis Sesabamisad ganviTarebuli metyvelebis fonze aRmocendeba afazia konvulsiur daavadebasTan erTad.

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• SesaZlebelia tipologiuri variacia.

• lks-is dros orsuloba, mSobiaroba da adreuli ganvi-Tareba normaluria. klasikurad lks aRmocendeba me-tyvelebis normaluri ganviTarebis garkveuli periodis Semdeg. mogvianebiT aRmoCnda, rom SemTxvevaTa 75%-Si metyvelebis deficiti jer kidev afaziamde vlindeba (Soprano, 1994), e.i. metyvelebis ganviTarebis paTologia, SeiZleba, win uswrebdes metyvelebis darRvevas da Semdeg dakargvas.

• metyvelebis dakargva ukavSirdeba gulyrebs (generali-zebuli, martivi an rTuli parcialuri, absansebi), an unilateralur, xSirad, marjvenamxriv eeg paroqsizmul aqtivobas (pikebi, an maxvili rxevebi, an pik-talRovani kompleqsebi), romlebic, ZiriTadad, Zilis nel fazaSi aRmocendeba.

• amtkiceben, rom lks Tanxvedrilia sxva epilefsiur md-gomareobebTan: mag. Zilis eleqtrul epilefsiur statu-sTan.

ZiriTadi niSnebi:

• gagebis gamoxatuli deficiti _ verbalur-smeniTi agno-zia, rac moicavs metyvelebiT smenas;

• SemTxvevaTa 70-75%-s aReniSneba epilefsiuri gulyrebi;

• 75%-s uvlindeba qceviTi aSliloba. 7 wlis da meti xan-grZlivobis gamokvlevebi miuTiTebs msubuq qceviT aSli-lobaze (hiperaqtivoba, impulsuroba, opoziciuri qceva), rac qronologiurad dakavSirebulia metyvelebis dar-RvevasTan da icvleba mis fluqtuaciasTan erTad;

• zepiri metyveleba bevrad mwiria, vidre weriTi, Tumca aRiniSneba werisa da maTematikuri unarebis gamoxatuli darRvevebic;

• nevrologiuri gamokvleviT paTologia ar vlindeba;

• araverbaluri inteleqti kargadaa Senaxuli;

• gamoqveynebul SemTxvevaTa naxevarSi pirvelad simptomad

��0

gagebis darRvevebia miTiTebuli, naxevarSi ki _ gulyre-bi;

• lks-is mqone pacientTa umravlesobis epilefsia mkurnalobas eqvemdebareba; gulyrebi ukuviTardeba pu-bertatis periodisaTvis;

• miuxedavad imisa, rom gulyrebsa da afazias Soris kore-lacia arsebobs, maTi gamovlineba, SeiZleba, erTmaneTs ar emTxveodes fazaSi. amdenad, maTi urTierTmimarTeba jer kidev gaurkvevelia.

SemTxvevaTa sixSire da risk-faqtorebi:

• �957-�995 ww.-Si gamoqveynebuli iyo �00 SemTxveva;

• mamrobiTi da mdedrobiTi sqesis pacientTa proporciaa _ �:�;

• ucnobia epidemiologiuri monacemebi sxvadasxva geogra-fiuli arealidan, infeqciur daavadebebTan, kvebisa da garemos dabinZurebasTan mimarTebaSi.

asakobrivi faqtorebi:

• SemTxvevaTa 50%-Si daavadeba iwyeba 3-dan 8 wlamde;

• iSviaTad iwyeba 8 wlis Semdeg, Tumca, aRwerilia me-tyvelebis darRvevis ramdenime SemTxveva 9 wlis Sem-degac. ufro mozrdili asakis SemTxvevaSi adgili aqvs, upiratesad, eqspresiuli metyvelebis moSlasa da sityvis moZebnis problemebs;

• asakTan dakavSirebuli prognozi Semdegia: rac ufro mc-irewlovania bavSvi, miT gaZnelebulia afaziis aRdgena.

afaziis xangrZlivobasTan dakavSirebuli faqtorebi:

• metyvelebis darRvevebi lks-is dros, SeiZleba, grZel-debodes Tveebi da wlebic ki;

• xangrZlivi periodis Semdeg, xSirad, cudi gamosavalia.

��

afaziis gamovlinebidan �0-�8 wlis Semdeg gamokvlevebi adasturebs metyvelebis darRvevebs;

• eeg maCveneblebis gaumjobesebisa da kontrolirebadi epilefsiuri gulyrebis miuxedavad, afaziis saboloo ga-mosavali Znelad prognozirebadia. prognozi individu-aluria _ yvela SemTxvevaSi afaziisa Tu eeg-paternebis remisia da fluqtuacia gansxvavebulia;

• paTologiuri eeg-paternebi afaziis mdgradobis mniS-vnelovani prediqtoria. rodesac eeg normalizdeba, mogvianebiT, pacientTa mxolod mcire nawils aqvs me-tyvelebis normalur donemde miRwevis unari; eeg-ze mdgradi paTologiuri paternebis arsebobis SemTxvevaSi rTuldeba metyvelebis aRdgena.

paTologia:

• Tavdapirvelad gaurkveveli iyo, lks-is dros aR-mocenebul metyvelebis darRvevas organuli xasiaTi hqonda Tu funqciuri. lks-is, rogorc organuli pa-Tologiis Sesaxeb mosazreba SemdgomSi sayovelTaod aRi-ares;

• iTvleba, rom lks-is dros adgili aqvs Tavis tvinis sam-etyvelo zonebSi fokalur, subklinikur epilefsiur gantvirTvebs;

• afaziis gamo lks, SeiZleba, dakavSirebuli iyos Zilis dros eleqtrofiziologiuri epilefsiuri statusis ar-seboba-ararsebobasTan. Tumca, aseTi statusis mqone bavS-vTa mcire raodenobas metyvelebis ganviTarebis specifi-kuri darRvevebi gaaCnia;

• Tav-zurg-tvinis siTxeSi adgili aqvs cilebis iol da saSualo xarisxiT momatebas, rac Tavis tvinSi iol fo-kalur anTebiT procesze miuTiTebs da SeiZleba, lks-is dros afaziis safuZvlad iyos miCneuli;

• lks zogierT SemTxvevaSi tvinis biofsiam gamoavlina cv-lilebebi, romlebic nela mimdinare virusul infeqciaze

��

miuTiTebda; aqedan gamomdinare, mkvlevrebma ivaraudes, rom qvemwvave virusuli encefalitebi orive hemisferos dazianebis Sedegad, SeiZleba, erTdroulad iwvevdes afa-ziasac da gulyrebsac;

• lks-is dros aRmoCenili iyo mielinis pozitiuri autoi-munuri reaqcia, ris Sedegadac daaskvnes, rom am dros darRveulia mielinis metabolizmi; aseve, dadginda, kor-tikosteroidebis, rogorc imunosupresorebis mkurnalo-baSi CarTvis dadebiTi efeqtic;

• kompiuteruli tomografiiTa da birTvul-magnitur-re-zonansuli gamokvlevebiT Tavis tvinis anomalia ar fiq-sirdeba;

• angiografiulad aRiniSneba saZile arteriebis zogierTi ganStoebis izolirebuli arteriti, rac miuTiTebs fo-kalur cerebrul vaskulitze, rogorc lks-is erT-erT paTogenezur meqanizmze;

• pozitronul-emisiuri tomografiuli gamokvleviT gamovlinda glukozis metabolizmis darRvevebi ZilSi. amasTan, metabolizmis done ufro dabali iyo qerqqveSa, vidre qerqul areebSi.

mkurnaloba:

• efeqturi mkurnalobis saboloo taqtika jer kidev Seu-muSavebelia;

• sxvadasxva saxis nacadi mkurnaloba (antiencefalituri, kortikosteroidebiT) warmatebuli iyo individualur SemTxvevebSi;

• lks-is dros, fokaluri vaskulitis modelis gamoyenebis safuZvelze, navaraudevi iyo kalciumis blokatorebiT SesaZlo Terapia;

• lks-is mqone pirebis reabilitaciaSi farTod iyeneben metyvelebis Terapias, vizualuri sferos intensiur trenings (kompiuteri, Jestebi, niSnebis ena), multimoda-lur midgomas.

��3

aRsaniSnavia, rom damoukideblad arc erTi Terapiuli programa ar aris efeqturi da saWiroa sxvadasxva saxis in-dividuri midgomis gamoyeneba.

metyvelebis sisxlZarRvovani etiologiis mqone darRvevebi

gansazRvreba:

• afazia aRmocendeba Tavis tvinis sisxlZarRvovani da-zianebis (insultis) dros, rodesac bavSvi uecrad an Tan-daTanobiT kargavs metyvelebis asakis Sesabamisad ganvi-Tarebuli unarebs.

• dazianebis lokalizacia damokidebulia insultis paTo-fiziologiaze. bavSvebSi insulti meoreulad viTardeba, intrakranialuri okluziis Sedegad da ZiriTadad, lo-kalizdeba bazalur gangliebSi; marcxena Txem-safeTqlis areebSi cerebruli arteritebisa da arteriovenozuri malformaciebis Sedegad ganviTarebuli kortikuli vaskuluri dazianebebi iwvevs afazias.

ZiriTadi niSnebi:

• afaziis tipi dazianebis lokalizaciazea damokidebuli: rodesac ziandeba marcxena hemisferos ukana sametyvelo kortikuli areebi, afazias sensoruli xasiaTi aqvs da motoruli xasiaTisaa, Tu upiratesad qerqqveSa midamoa dazianebuli;

• sensoruli afaziis dros vlindeba anomia, sityvebis Zie-bis gaZneleba, parafaziebi;

• qerquli dazianebis dros wera-kiTxvis unari, SesaZlebe-lia, garkveulwilad Senaxuli iyos;

• kiTxvisa da weris darRvevebi, Cveulebriv, Tan axlavs mwvave da qronikul qerqqveSa vaskulur dazianebas.

��4

SemTxvevaTa sixSire: • aRwerilia erTeuli SemTxvevebi. risk-faqtorebi:asakTan dakavSirebuli faqtorebi:

• afazia, SeiZleba, aRmocendes bavSvobis nebismier asakSi.

drosTan dakavSirebuli faqtorebi:

• vaskuluri dazianebis Semdeg adgili aqvs afaziis simp-tomebis mniSvnelovan aRdgenas, Tumca, saxeldebisa da sityvis moZebnis problemebi, SeiZleba, vrceldebodes Soreuli aRdgenis periodis stadiazec.

paTologia:

• qerquli dazianebis lateralizacia da lokalizacia ise-Tivea, rogoric mozrdilebSi;

• bavSvebSi sisxlZarRvovani subkotrikuli afaziebi aRmo-cendeba zustad iseTive subkotrikuli dazianebis Sede-gad, rogoriTac mozrdilebSi.

mkurnaloba:• araspecifikuria.

qala-tvinis travmis Tanmxlebi metyvelebis darRvevebi

gansazRvreba:

• afazia, SeiZleba, aRmocendes qala-tvinis travmis, Cveu-lebriv, daxuruli travmis Semdeg;

• afazias win uZRvis Tavis tvinis dazianeba (kontuziebi, difuzuri aqsonaluri dazianeba) da eqstrakranialuri faqtorebi (hipoqsia, hipertenzia);

• miRebuli travmis adgilmdebareobis miuxedavad, tvinis fokaluri kontuziis dros, yvelaze xSirad, Tavis tvi-nis Sublisa da safeTqlis wilebi ziandeba.

��5

ZiriTadi niSnebi:

• qala-tvinis travmis Semdeg bavSvebs aReniSnebaT afaziis simptomebi;

• iSviaTad aRmocendeba mozrdilebis msgavsi da wminda afaziuri sindromebi;

• qala-tvinis travmis Semdgom, xanmokle periodSi, xSirad qveiTdeba verbaluri produqcia da viTardeba mutizmi.


• amerikis SeerTebul Statebsa da evropaSi bavSvTa sikvdi-lianobis erT-erT ZiriTad mizezs qala-tvinis travma warmoadgens. weliwadSi bavSvTa travmis �0000-i SemTxve-vidan daaxloebiT �0 mTavrdeba letaluri gamosavliT. qala-tvinis mZime travmis mqone gadarCenili bavSvebidan 80%-s aReniSneba swavlis problemebi da verbaluri una-rebis gamoxatuli daqveiTeba.

asakobrivi faqtorebi:

• travmas, SeiZleba, adgili hqondes bavSvobis nebismier periodSi;

• adreul asakSi miRebuli travmis aRdgeniT periodSi (travmidan 8 Tvis Semdgom), ZiriTadad, eqspresiuli me-tyvelebis deficitia gamoxatuli;

• 7 wlamde miRebuli qala-tvinis travma SemdgomSi, SeiZ-leba, xangrZlivi sirTuleebis mizezi gaxdes saxis eqs-presiis cnobasa da metalingvistur unarebSi.


• qala-tvinis travmis Sedegad aRmocenebuli afaziuri simptomebi garkveuli periodis Semdeg qreba;

• bavSvTa qala-tvinis travmis Semdeg anomia da daqveiTebu-

��6

li verbaluri moqniloba mdgradi deficitia, travmidan Tundac �8 Tvis Semdeg;

• qala-tvinis travmis Semdeg bavSvebs aReniSnebaT prob-lemaTa mTeli rig, rasac, SeiZleba, pirobiTad araaf-aziuri metyvelebis darRveva ewodos. travmidan xan-grZlivi periodis ganmavlobaSi bavSvebs aReniSenebaT msjelobis deficiti _ ambis moyolisas, idiomaturi gamoTqmebis gagebisa da gamoyenebis dros; uqveiTdebaT garkveuli konteqstis Sesaferisi sametyvelo aqtebis ganxorcielebis unari; komunikaciis problemebi Sedar-ebiT iSviaTia;

• travmis Semdgom bavSvebs xangrZlivad rCebaT gagebis problemebi iseTi davalebebis Sesrulebisas, rodesac saWiroa gaurkveveli semantikuri SerCevis wesebisa da rTuli gramatikuli struqturebis momcveli msjelo-bebis Sefaseba;

• bavSvebs, romlebsac qala-tvinis travma adreul asakSi aqvT miRebuli, travmidan xangrZlivi periodis ganmav-lobaSi daqveiTebuli aqvT mimarTuli komunikaciis una-ri, rac gulisxmobs instruqciis Sesaferisi daskvnis ga-motanis problemebsa da metakognituri funqciis defi-cits;

• qala-tvinis travmis Semdgom bavSvebs sakmaod xangrZlivi periodis ganmavlobaSi uWirT enis gamoyeneba socialur-komunikaciuri miznebis misaRwevad;

• qala-tvinis travmis Semdgom, bavSvebSi xangrZlivi peri-odiTaa daqveiTebuli metyvelebasTan dakavSirebuli aka-demiuri Cvevebi;

• droTa ganmavlobaSi, SeiZleba, qveiTdebodes leqsiko-nis testebis maCveneblebi, radganac qala-tvinis travmis mqone bavSvebs uWirT leqsikuri maragis SeZena maTi asa-kis Sesatyvisad.

��7

paTologia:

• metyvelebis rezidualuri darRvevis xarisxi damokideb-ulia qala-tvinis travmis simZimeze. msubuqi travmis Sem-deg metyvelebis funqciebi ufro swrafad aRdgeba, vidre SedarebiT mZime travmis Semdeg;

• bavSvTa qala-tvinis travmis Sedegad aRmocenebul me-tyvelebis darRvevebisa da klinikur-paTologiuri mona-cemebis korelacia naklebadaa garkveuli, gansakuTrebiT, roca kontuziuri dazianeba moicavs Sublisa da safeTq-lis areebs. Tumca, cnobilia, rom bavSvebsa da mozard-ebSi Sublisa da marcxena hemisferos kontuziebi dakav-Sirebulia metalingvisturi unaris deficitTan.

ukana fosos simsivneebTan Tanxlebuli metyvelebis darRvevebi

gansazRvreba:

afazia aRmocendeba naTxemis, meoTxe parkuWisa da tvinis Reros astrocitomis, meduloblastomis, an ependimomis dros da vlindeba SeZenili metyvelebis unarebis swrafi, progresirebadi daqveiTebiT.

ZiriTadi niSnebi:

• bavSvebSi mutizmi xSiria naTxemis dazianebis mwvave peri-odSi;

• mutizmi ar aris damokidebuli simsivnis specifikaze; igi vlindeba sxvadasxva saxis simsivnis dros;

• saxezea mutizmis sindromi Semdgomi dizarTriiT, rac ar aris dakavSirebuli naTxemis ataqsiasTan. igi xasaiTdeba metyvelebis sruli, magram gardamavali dakargviT da SemdgomSi, dizarTriaSi gadazrdiT;

• bavSvebSi ukana fosos simsivnesTan Tanxlebuli dizar-

��8

Tria Zalze waagavs mozrdilTa dizarTrias artiku-latoruli SeferxebebiT, gaxangrZlivebuli fonemebiT, intervalebiT, metyvelebis neli tempiT, xmis simaRlis kontrolis naklovanebiT, uxeSi xmiT, xmis tonis simaR-lis cvalebadobiT;

• bavSvTa ukana fosos simsivneebis dros mozrdilTa msgavsi motoruli an sensoruli afazia ar vlindeba, Tumca, adgili aqvs metyvelebis darRvevebs zepir eqspresiaSi, an gagebaSi.


• �994 wlamde mutizmisa da misi Semdgomi dizarTriis sul 34 SemTxveva iqna aRwerili;

• ukana fosos simsivneebis mqone bavSvebSi mutizmisa da misi Semdgomi dizarTriis aRmocenebis risk-faqtoria hi-drocefalia an tegmentumis postoperaciuli SeSupeba.

asakTan dakavSirebuli faqtorebi:

mutizmisa da misi Semdgomi dizarTriis mqone pacientebis 90%-is asaki �0 welze naklebia; es mdgomareoba � wlis bavSvebSicaa aRwerili.


• mutizmisa da misi Semdgomi dizarTriis SemTxvevaSi dizarTriis normalur metyvelebamde aRdgena dakavSire-bulia enisa da piris (sametyvelo aparatis) kompleqsuri moZraobis aRdgenasTan;

• ukana fosos simsivnis mqone bavSvebs xanmokle da xan-grZlivi periodis Semdeg, sxvadasxva xarisxiT aReniSne-baT inteleqtualuri, neirofsiqologiuri da akademiuri siZneleebi. naTxemis astrocitomasTan SedarebiT, akade-miuri siZneleebi ufro xSiria ukana fosos meduloblas-tomis mqone bavSvebSi.

��9

paTologia:

• mutizmi, Cveulebriv, aRmocendeba ukana fosos simsivnis dros, romelic naTxemis WiaSi an orive hemisferoSia lokalizebuli da Rrma birTvebsac moicavs;

• mutizmi, SeiZleba, aRmocendes Suamdebare lokalizaciis simsivnis postoperaciul garTulebis Sedegad, rode-sac ziandeba Suamdebare struqturebi da Tavis tvinis fexebi;

• naTxemis struqturebis izolirebuli dazianeba sakmarisi ar aris mutizmisa da dizarTriis aRmocenebisaTvis; misi ganviTarebisaTvis aseve aucilebelia, simsivnis ventri-kuluri lokalizacia da misi tvinis Reros dorzalur nawilTan Sexeba;

• mutizmisa da misi Semdgomi dizarTriis mqone bavSvebs xSirad aReniSnebaT piramiduli niSnebi, Tvalis moZrao-bis darRvevebi;

• mutizmisa da misi Semdgomi dizarTriis dros simsivnis tvinis ReroSi lokalizacia, Cveulebriv, mogrZo tvinis rostralur da Sua tvinis kaudalur nawilebs moicavs;

• fiqroben, rom mutizmi dakavSirebulia naTxemis dakbi-luli birTvis disfunqciasTan, misi Semdgomi dizarTria ki _ naTxemis meqanizmebis aRdgenaze miuTiTebs.

mkurnaloba:

aseT SemTxvevebSi mutizmis Terapiuli taqtika ara-specifikuria da gulisxmobs mxolod simsivnis sawinaaRm-degod mimarTul mkurnalobas.

Tavis tvinis dazianebis Semdeg, bavSvebSi klinikurad vlindeba sxvadasxva saxis metyvelebis darRvevebi. maT dasaZlevad mimarTaven neirfosiqologiur reabilitacias da metyvelebis Terapias.

�30

asakTan dakavSirebuli sakiTxebi:

• adreul asakSi SedarebiT xSiria metyvelebis pragmatuli darRvevebi, sxvisi ganzraxvisa da mdgomareobis gagebis sirTule komunikaciis procesSi;

• Tavis tvinis dazianebis Soreuli efeqti metyvelebis sxva-dasxva funqciis SemTxvevaSi sxvadasxvaa: Tu epilefsiis dawyeba emTxveva wera-kiTxvis Seswavlis dawyebis asaks, adgili eqneba weriTi metyvelebis aTvisebis darRvevas. gamokvlevebis mixedviT dadgenilia, rom is unarebi rom-lebic dazianebis momentSi aqtiuri ganviTarebis period-Si imyofeba da jer kidev Camouyalibebelia, gansakuTre-biT mgrZnobiarea dazianebisadmi.

• Tavis tvinis sxvadasxva etiologiis dazianeba bavSvebSi gacilebiT xSirad iwvevs mutizms, vidre ufrosebSi;

• mozrdilTa da bavSvTa afazia hgavs erTmaneTs, rac ar niSnavs maTi afaziuri simptomebis identurobas. maga-liTad, afaziis erTnairi etiologiis pirobebSi mozr-dilTa da bavSvTa metyvelebis deficiti msgavsia; bavS-vebSi, iseve rogorc mozrdilebSi, marcxena hemisferos ukana sametyvelo areebis dazianeba iwvevs sensorul afaziasa da mimarTuli metyvelebis gagebis darRvevas. kompiuteruli tomografiis maCveneblebis korelacia afaziis simptomebTan mozrdilebis msgavsia. amave dros, bavSvTa da mozrdilTa afazia ar aris identuri; erTi SexedviT msgavs afaziur simptomebs, SeiZleba, sxvadasxva neiroanatomiuri safuZveli hqondes;

• mozrdilebSi, garkveuli drois Semdeg, sxvadasxva xaris-xiTa da tempiT umjobesdeba metyveleba da ukuviTardeba afazia. bavSvebSi, dro yovelTvis dadebiTad ar moqme-debs afaziis simptomebze: bavSvebSi, SeiZleba, afaziis simptomebi aRar iyos saxeze, magram xSirad vlindebodes axali verbaluri codnis SeZenis problemebis xangrZlivi efeqti, rac leqsikuri maragisa da kiTxvis qronikuli problemebis mizezi xdeba.

�3�

rogoria bavSvTa afaziis aRdgenis dinamika?

etiologiuri faqtoris mixedviT, afaziis aRdgenis dro da xangrZlivoba gansxvavdeba. qala-tvinis travmis Sedegad aRmocenebuli afaziis simptomebi bevrad ufro adre aRd-geba, vidre infeqciis, an vaskuluri paTologiis SemTxve-vaSi. afaziis xangrZlivobisa da droSi aRdgenis sakiTxi metad mniSvnelovania bavSvTa afaziis Teoriuli modelis asagebad. Tumca, dReisaTvis jer kidev araa mowodebuli Teoria, romelic gamodgeboda bavSvis afaziis meqanizmebis safuZvlebis asaxsnelad. Tanamedrove samuSao hipoTeziT, erTi da igive afaziuri simptomebi, SeiZleba, nervuli me-qanizmebis sxvadaxva saxis dazianebis Sedegi iyos. mag. afa-ziuri mutizmis aRdgenis xangrZlivoba gansxvavebulia su-pratentoruli da subtentoruli dazianebis SemTxvevebSi; ukana fosos simsivnis dros mutizmi dizarTriaSi gadadis, xolo vaskuluri subkortikuli dazianebis dros igi di-zarTriaSi ar gadaizrdeba.

bavSvTa afaziebis taqsonomia sakmaod rTulia, mozr-dilTa metyvelebis darRvevebis klasifikacia ki adekvatu-rad ver aRwers bavSvTa metyvelebis SeZenili darRvevebs, radgan mozrdilTa metyvelebis darRvevebis klasifikacia-Si ar aris gaTvaliswinebuli kognituri funqciebisa da me-tyvelebis ganviTarebis faqtorebi. aRniSnulis gamo bavS-vTa afaziis SemTxvevaTa 30-50%-i ver klasificirdeba.

rogoria bavSvTa afaziis prognozi?

afaziis aRdgenis prognozi arakeTilsaimedoa infeq-ciuri etiologiis, vernikes zonis dazianebisa da Zlier darRveuli gagebis funqciis SemTxvevebSi.

�3�

metyvelebis ganviTarebis darRveva, dauzustebeli

ICD 10-is metyvelebis ganviTarebis darRvevebis kla-sifikaciis mixedviT metyvelebis ganviTarebis specifikur darRvevebSi calkea gamoyofili metyvelebis ganviTarebis dauzustebeli darRveva. am rubrikis gamoyeneba mowo-debulia mxolod im SemTxvevaSi, Tu saxezea metyvelebis gaurkveveli darRvevebi, romlebic ar aris gamowveuli go-nebrivi CamorCenilobiT, an nevrologiuri, sensoruli Tu fizikuri defeqtebiT.

socialuri funqcionirebis sxva darRvevebi, romlebic ZiriTadad bavSvobisa da mozardobis

asakSi iwyeba (ICD-10)

ICD-�0-is mixedviT socialuri funqcionirebis sxva darRvevebSi, romlebic ZiriTadad bavSvobisa da mozardo-bis asakSi iwyeba, gamoyofilia metyvelebis iseTi darRveve-bi, rogoricaa enis borZiki da uwesrigo metyveleba.

enaborZikoba

enaborZikobis diagnostikuri kriteriumebi ICD-10-is mixedviT

enaborZikoba metyvelebis iseTi darRvevaa, rodesac ad-gili aqvs lingvisturi komunikaciis mxolod gamosavlis da ara mTliani procesis darRvevas. gaZnelebulia zogierTi bgeris gamoTqma. am darRvevis dros metyveleba xasiaTde-ba bgerebis, marcvlebis an sityvebis xSiri gameorebebiTa da prolongaciiT, metyvelebis dros xSiri SeferxebebiT an pauzebiT, rac metyvelebis riTmul mimdinareobas arRvevs. msgavsi tipis msubuqi dizriTmiebi sakmaod gavrcelebuli fenomenia da xSiria rogorc ganviTarebis gardamavali faza adreul bavSvobaSi. aseTi dizriTmiebi SeiZleba iyos ufro ufrosi bavSvebisa da zrdasrulebis metyvelebis mudmivi Tavisebureba. msgavsi ram unda klasificirdebodes, rogorc

�33

darRveva mxolod im SemTxvevaSi, Tu is imdenadaa gamoxa-tuli, rom sakmarisad arRvevs metyvelebis moqnilobasa da gaugebars xdis mas. gameorebebs, prolongaciebs an pauzebs metyvelebaSi SeiZleba Tanxvdebodes saxisa da/an sxeulis sxva nawilebis asocirebuli moZraobebi. enaborZikoba unda gamodiferencirdes uwesrigo metyvelebisa da tikebisagan. zogierT SemTxvevaSi enaborZikoba SeiZleba iyos metyvele-bis ganviTarebis specifikur darRvevebTan erTad.

unda gamoiricxos:

• uweserigo metyveleba (F 98.6);

• nevrologiuri darRvevebi, romlebic ganapirobeben me-tyvelebiT dizriTmiebs (ICD 10, Tavi VI);

• obsesiur-kompulsiuri aSliloba (F 42-);

• tikuri aSliloba (F95-).

enaborZikobis diagnostikuri kriteriumebi DSM-IV-TR-is mixedviT

A. metyvelebis moqnilobisa da droiTi maxasiaTeblebis (individis asakTan Seusabamod) darRveva, romelic xa-siaTdeba qvemoT CamoTvlili mdgomareobebidan er-TiT an ramdenimeTi:

�. bgeris da marcvlis gameoreba;

�. bgeris prolongacia;

3. wamoZaxili;

4. sityvis gawyveta (mag.: pauza sityvis SigniT);

5. Cumi an gasagebi blokireba (Sevsebuli an Seuvsebe-li pauzebi metyvelebaSi);

6. Canacvleba (uxvsityvaoba) (sityvis Canacvleba pro-blemuri sityvis Tavidan aridebis mizniT);

7. sityvis warmoTqma fizikuri daZabulobiT;

8. erTmarcvliani sityvebis gameoreba (mag.: me-me-me-me vxedav mas).

�34

B. moqnilobis darRveva zegavlenas axdens akademiur mi-Rwevebze, yoveldRiuri cxovrebis aqtivobebze an so-cialur komunikaciaze.

C. Tu adgili aqvs metyvelebis motorul an sensorul deficits metyvelebis sirTuleebi, rogorc wesi da-kavSirebulia am problemebTan.

SeniSvna: Tu adgili aqvs metyvelebis motorul, an sen-sorul deficits, an nevrologiur mdgomareobas, unda ga-moiyenoT III RerZi.

enaborZikobis gamomwvevi mizezebi

anatomiur-fiziologiuri mizezebia: fizikuri daava-debebi, romlebic iwveven encefalopaTiebs, Tavis tvinis travmebi, Tavis tvinis organuli dazianebebi, romlebic iwveven moZraobis regulaciaze pasuxismgebeli qerqqveSa struqturebis dazianebas, nervuli sistemis gadaRla an gamofitva intoqsikaciis an sxva daavadebebis Sedegad (wi-Tela, yivanaxvela, tifi, raqiti, nivTierebaTa cvlis moS-la), bgeraTwarmoTqmis problemebi metyvelebis sxvadasxva darRvevebis dros.

fsiqologiuri da socialuri mizezebia: xanmokle er-Tjeradi fsiqikuri travma (SeSineba), xangrZlivad moqmedi fsiqikuri travma, rac gulisxmobs ojaxSi bavSvis araswor aRzrdas (ganebivreba, aRzrdis imperatiuli stili, `sama-galiTo~ bavSvis aRzrda), xangrZlivi uaryofiTi emociebi, gadaWarbebuli sixaruli, bavSvobaSi metyvelebis araswori formireba (metyveleba CasunTqvisas, swrafi metyveleba), bgeraTwarmoTqmis darRveva, mSobelTa swrafi metyveleba, umcrosi asakis bavSvis sametyvelo masaliT gadatvirTva, poliglosia (adreul asakSi ramdenime enis Seswavlam Sesa-Zloa gamoiwvios eniaborZikoba erT romelime enaze), ena-borZikobis mibaZva, caciobasTan brZola (aucileblad mar-jvena xeliT wera), xSiri SeniSvnebi (iwvevs bavSvis daZabvas, ramac SesaZloa gamoiwvios enaborZikoba).

�35

gavrcelebaenaborZikobis gavrceleba prepubertatis asakis bavSvebSi Seadgens � %-s, xolo zrdasrulebSi – 0,8%-s. mamakacTa da qalTa proporciaa 3:�.

rogor davexmaroT enaborZikobis mqone bavSvs?

• diagnostirebisa da metyvelebis problemebis daZlevisa-Tvis mSoblebma aucileblad unda mimarTon logopeds, fsiqologs, nevrologs.

• bavSvTan urTierTobisas axloblebma unda daicvan Semde-gi wesebi:

o ar SeawyvetinoT saubari, acaleT frazis damTavreba; ar daamTavroT bavSvis magivrad arc sityva, arc fra-za; metyvelebis xSiri Sewyveta sxvebis mxridan bavSvs aiZulebs aCqardes da SeSfoTdes; mas gauCndeba sur-vili, rom ufro swrafad ilaparakos, raTa yvelafris Tqma moaswros, es ki Tavis mxriv xels Seuwyobs ena-borZikobis gaZlierebas;

o mas Semdeg rac bavSvma daamTavra raime frazis Tqma, gaakeTeT mcire pauza, riTac bavSvs miscemT dasvene-bis saSualebas; Tqvenc gaakeTeT patara pauza manam, sanam komentars gaukeTebdeT mis naTqvams;

o ecadeT, rom ojaxSi yvelam rig-rigobiT isaubroT, bolomde mousminoT erTmaneTs, ar SeawyvetinoT erT-maneTs laparaki, isaubreT neli tempiT;

o gamoyaviT dro, romelsac mTlianad Tqvens bavSvs dauTmobT. am dros esaubreT bavSvs Zalian nela, mS-vidad. dialogi warmarTeT CurCuliT an wamRerebiT (am dros bavSvis yuradReba gadadis imaze, rom ilapa-rakos rac SeiZleba Cumad da ar fiqrobs enis dabma-ze).

o ar mosTxovoT bavSvs raime sityvebis an winadadebebis gameoreba;

�36

o nu gaakritikebT Tqveni bavSvis metyvelebas. frazebi: `Sewyvite~, `moicade~, `jer dafiqrdi da mere Tqvi~ ara Tu ar exmareba, aramed kidev ufro aZlierebs enaborZikobas. bavSvi iZabeba, cdilobs ar daebas ena, xolo damatebiTi daZabuloba kidev ufro aZlierebs enaborZikobas;

o Tavi aarideT iseT situaciebs, sadac bavSvi iZabeba, ganicdis zewolas. bavSvebs uZlierdebaT enaborZi-koba, Tu maT Zalian bevr kiTxvas usvamen, an raimes moyolas Txoven (mag: ̀ mouyevi mamas, an deidas dRes ra gavakeTeT~);

o ecadeT daicvaT bavSvis dRis reJimi, ar gadatvirToT informaciiT dRis manZilze da gansakuTrebiT Zilis win (iqneba es televizorTan xangrZlivi jdoma, Tu misTvis rTuli teqstebis moyola);

o TxoveT maswavlebels, rom Tavidan bavSvs dafasTan gasvla da raimes moyola ar moTxovos, gakveTili (Tundac suraTis aRwera) SeiZleba gamokiTxos kiTxva-pasuxiT;

o kargi iqneba Tu bavSvs SeiyvanT cekvis an simReris wreze.

•saskolo asakis bavSvebs unda auxsnaT Semdegi wesebi:

o sanam saubars daiwyebde moifiqre, risi Tqma gsurs;

o nu aCqardebi pasuxis gacemis dros – pasuxi jer Sen-Tvis, Cumad Cailaparake;

o saubris dros mosaubres uyure TvalebSi;

o didi winadadeba dayavi azrobriv nawilebad (3-5 si-tyva), maT Soris daicavi pauza;

o ecade isaubro xmamaRla da garkveviT;

o saubris dawyebis win CaisunTqe, saubari daiwye amo-sunTqvisas.

�37

uwesrigo metyveleba

uwesrigo metyvelebis diagnostikuri kriteriumebi ICD-10-is mixedviT

es darRveva xasiaTdeba metyvelebis swrafi tempiT, me-tyvelebis moqniloba imdenadaa darRveuli (enaborZikobis damaxasiaTebeli gameorebebisa da Seferxebebis gareSe), rom metyveleba gaugebari xdeba. metyveleba, rogorc wesi, aris uwesrigo, dizriTmiuli, damaxasiaTebelia uecari mkveTri `biZgebi~. xSirad irRveva frazebis ageba (mag.: pauzebi ue-crad icvleba `Zlieri sametyvelo nakadiT~, romlis dro-sac sityvaTa jgufebi winadadebis gramatikul wyobasTan SeuTvasebelia).

unda gamoiricxos:

• nevrologiuri darRvevebi, romlebic ganapirobeben metyvelebiT dizriTmiebs (ICD 10, Tavi VI);

• obsesiur-kompulsiuri aSliloba (F 42-);

• enaborZikoba (F 98.5);

• tikuri aSliloba (F95-).

DSM-III-Si kategoriaSi “metyvelebis darRvevebi, rom-lebic klasifikacias ar eqvemdebareba” enaborZikobis gar-da aRiniSneba uwesrigo metyveleba.

DSM-III-is mixedviT uwesrigo metyveleba metyvelebis moqnilobis iseTi darRvevaa, romelic metyvelebis siswra-fes da ritms moicavs. metyveleba dizriTmiuli, wyvetili, araTanabari xasiaTisaa. DSM-IV-Si metyvelebis darRvevis es kategoria aRar gvxvdeba.

eleqtiuri mutizmi (seleqtiuri mutizmi)

es mdgomareoba metyvelebiTis unarebis gamovlenis emociurad ganpirobebuli SerCeviTobiT xasiaTdeba. amgva-rad, garkveul pirobebSi bavSvi metyvelebis flobis sak-

�38

maris unars avlens, xolo sxva (gansazRvrul) situaciebSi ara. yvelaze xSirad darRveva vlindeba adreul bavSvoba-Si. is orive sqesis bavSvebSi erTnairi sixSiriT gvxvdeba. mutizmi, rogorc wesi, Tanxvedrilia iseT pirovnul Ta-viseburebebTan, rogoricaa socialuri SfoTva, gariyulo-ba, sensitiuroba an negativizmi. tipur SemTxvevebSi, bavSvi laparakobs ojaxis wevrebTan da axlo megobrebTan da dums skolaSi, ucxo adamianebTan.

eleqtiuri mutizmis diagnostikuri kriteriumebi ICD-10-is mixedviT eleqtiuri mutizmis diagnozi gulisxmobs Semdegs:

o mimarTuli metyvelebis normaluri an praqtikulad normaluri gageba;

o eqspresiuli metyvelebis ganviTarebis done unda iyos sakmarisi socialuri urTierTobisaTvis;

o demonstraciuli dadastureba imisa, rom bavSvs aqvs unari (da iyenebs am unars) normalurad an praqti-kulad normalurad metyvelebdes garkveul situa-ciebSi.

aRsaniSnavia, rom eleqtiuri mutizmis mqone bavSvebis mniSvnelovan nawils aReniSneba metyvelebis ganviTarebis Seferxeba. am SemTxvevebSi es diagnozi SeiZleba daisvas mxolod im pirobiT, rom metyveleba sakmarisad aris ganvi-Tarebuli efeqturi urTierTobisaTvis garSemomyofebTan da amasTan, adgili aqvs gamoxatul Seusabamobas metyvele-bis ganviTarebis donesa da metyvelebis komunikaciisaTvis gamoyenebis xarisxs Soris: bavSvi kargad metyvelebs gark-veul situaciebSi da sruliad an TiTqmis sruliad dums sxva situaciebSi. diagnozis dasmisaTvis aucilebelia me-tyvelebis darRvevis droSi mdgradoba da im situaciebis Tanmimdevroba da winaswarmetyvelebis SesaZlebloba, rom-lebSic bavSvi metyvelebs an dums. SemTxvevebis umravlesobaSi bavSvebs aReniSnebaT socialu-ri emociebis sxva darRvevebic, magram isini ar Sedian im kriteriumebis ricxvSi, romlebic aucilebelia am diagno-zis dasmisaTvis. Taviseburebebi (kerZod, socialuri sensi-tiuroba, socialuri SfoTva da socialuri gariyuloba) da opoziciuri qceva.

�39

unda gamoiricxos:

• ganviTarebis zogadi darRvevebi (F 84.-);

• Sizofrenia (F 20.-);

• metyvelebis ganviTarebis specifikuri darRvevebi (F 80.-);

• tranzitoruli mutizmi, rogorc SfoTviTi aSlilobis nawili, romelic aRmocendeba umcrosi asakis bavSvebTan ganSorebis SiSis niadagze (F93.0-).

seleqtiuri mutizmis diagnostikuri kriteriumebi DSM-IV-TR-is mixedviT

A. specifikur socialur situaciebSi (mag.: skolaSi) me-tyvelebis mdgradi darRveva, maSin roca sxva situa-ciebSi metyveleba ar aris darRveuli.

B. darRveva zegavlenas axdens akademiur miRwevebze, yo-veldRiuri cxovrebis aqtivobebze an socialur komu-nikaciaze.

C. darRvevis xangrZlivoba unda iyos minimum � Tve (ar unda Semoifarglebodes mxolod skolaSi misvlis pirveli � TviT).

D. metyvelebis problema ar aris gamowveuli socialur situaciaSi metyvelebis gamoyenebis arcodniT an so-cialur garemoSi metyvelebis diskomfortiT.

E. darRveva ufro metad ar unda miesadagebodes komu-nikaciur darRvevebs (mag.: enaborZikoba) da ar unda gvxvdebodes iseTi mdgomareobebis dros, rogoricaa ganviTarebis pervesiuli aSliloba, Sizofrenia, an sxva fsiqoturi aSliloba.

gavrcelebaseleqtiuri mutizmi, savaraudod iSviaTia da am mdgoma-reobis mqone adamianebi fsiqikuri janmrTelobis dawesebu-lebebSi moxvedrili individebis � %-ze naklebs Seadgenen.

�40

rogor xdeba metyvelebis darRvevis Sefaseba?

gamoyofilia Sefasebis Semdegi funqciebi:

• bavSvis metyvelebis darRvevis identifikacia;

• darRvevis xasiaTis diagnostika;

• intervenciis dagegmva;

• intervenciis procesSi bavSvis progresis monitoringi;

• bavSvis metyvelebis ganviTarebis prognozireba.

idealur SemTxvevaSi metyvelebis problemebis Sefaseba xdeba multidisciplinuri gundis mier, romelSic erTian-debian sxvadasxva dargis specialistebi. aucilebelia, bavS-vis pediatriuli da nevrologiuri gamokvlevis Sedegebis codna. bavSvis Sesafaseblad gamoiyeneba interviu, dakvir-veba, metyvelebis Sesafasebeli standartuli testebi, ara-verbaluri inteleqtis Sesafasebeli testebi. Sesafaseblad sasargebloa veqsleris IQ teestisaraverbaluri subteste-bis gamoyeneba.

Tu araverbaluri inteleqtis testis, eqspresiuli da impresiuli metyvelebis testebisa da adaptaciuri qcevis skalebis maCveneblebi � standartuli gadaxriT naklebia saSualo maCvenebelze, metyvelebis problema meoradi xa-siaTisaa. Tu araverbaluri inteleqti normaSia, xolo eqs-presiuli da impresiuli metyvelebis maCveneblebi saSua-loze �.5-� standartuli gadaxriT dabalia, adgili aqvs metyvelebis ganviTarebis specifikur Seferxebas.

metyvelebis ganviTarebis specifikuri Seferxeba saWi-roebs diferencialur diagnostikas Semdeg sindromebTan: autizmi, landau-klefneris sindromi da eleqtiuri mutiz-mi.

autizmis dros xSiria eqolaliebis, stereotipuli ga-moTqmebis, Jestebis simwire, xmis tembrisa da intonaciis mimarT indiferentuloba, warmosaxviTi TamaSis SeuZle-bloba.

landau-klefneris sindromis dros (epilefsia Tandar-Tuli afaziiT) metyvelebis normaluri ganviTarebisa da

�4�

normaluri inteleqtis fonze darRveulia eqspresiuli da impresiuli metyveleba. es sindromi 3-7 wlis asakSi aRmo-cendeba da eeg-ze Tan axlavs safeTqlis bilateraluri pa-Tologiuri aqtivoba. Sereuli eqspresiul-impresiuli me-tyvelebis darRveva SemTxvevaTa �/3-Si ukuviTardeba, xolo �/3-Si myarad rCeba.

eleqtiuri mutizmis dros bavSvis metyvelebis ganviTa-reba normalurad mimdinareobs, magram fsiqo-socialuri mizezebis gamo bavSvi ar metyvelebs konkretul situacieb-Si: aseTi bavSvi laparakobs ojaxis situaciaSi da axlo nac-nob-megobrebTan, magram Cumadaa skolasa da sazogadoebriv adgilebSi.

Lahey (�988) miuTiTebs im saSualebebze, romelTa gamoye-nebiTac metyvelebis darRveva fasdeba farTo speqtriT _ standartuli Sefasebidan dawyebuli, damTavrebuli bune-brivi dakvirvebiT.

metyvelebis specifikuri darRvevis Sesafaseblad au-cilebelia yuradRebis gamaxvileba enis 5 aspeqtze:

• fonologia _ gulisxmobs fonemebis JReradobas da si-tyvaSi Tu morfemaSi maTi funqcionirebis wesebs. tra-diciulad, fonologia moiazreba artikulaciuri unare-bis terminebSi, Sesabamisad, Sefasebisas bavSvebs Txoven sagnebi daasaxelon suraTebis mixedviT. amiT dgindeba, Tu ramdenad SeuZlia bavSvs rTuli bgerebisa da bgera-Ta wyobis gamoTqma sityvebSi. fonologiis gamokvleva Cveulebriv eqspresiul metyvelebaSi xdeba, Tumca, xan-daxan smeniTi aRqmisa da fonemebis garCevis Sefasebasac axdenen. fonologiis Sesafasebeli testebis validoba kiTxvis niSnis qveSaa.

• semantika _ gulisxmobs mniSvnelobebs, romelic sityve-bsa da winadadebaSia kodirebuli. ufro xSirad igi leqsikonis testebiT fasdeba. kerZod, xdeba rogorc eqspresiuli (dasaxeleba), ise impresiuli (suraTebis identifikacia) unarebis gamokvleva. semantikis sxva as-peqtebi, rogoricaa sityvebis gansazRvreba, analogiebi, sityvebs Soris mimarTebis dadgena, xSiradaa CarTuli lingvisturi unarebis sakvlev testebSi.

�4�

• sintaqsi _ gulisxmobs gramatikuli struqturisa da konstruqciis gagebis unars. receptuli (impresiuli) sintaqsi xSirad fasdeba suraTis amorCevis formatis testebiT, rodesac wakiTxuli winadadebis mixedviT ra-mdenime suraTidan erT-erTi, Sesaferisi suraTi unda iqnas arCeuli. eqspresiuli sintaqsi, anu gramatikulad gamarTuli winadadebis gamoTqmis unari, xSirad mowm-deba winadadebis swori gameorebiT. Tumca, ukanaskneli periodis kvlevebi am teqnikas saeWvod miiCnevs, radgan winadadebis gameoreba ar aris misi formulirebis una-ris analogiuri. Sesabamisad, bavSvebi am or SemTxvevaSi gansxvavebul Secdomebs uSveben. Tanamedrove praqtika-Si SedarebiT xSirad mimarTaven bunebriv garemoSi bavS-vis metyvelebaze dakvirvebas, spontanuri metyvelebis dros gamonaTqvamebis Segrovebasa da analizs.

• morfologia _ gulisxmobs sufiqsebis, prefiqsebisa da sxvadasxva nawilakebis darTviT sityvis Camoyalibebis wesebs. morfologiuri codna moicavs mravlobiTis, warsulis, momavlis, zmnis formebis, kuTvnilebiTi formebis warmoebasa da gamoyenebas. zogadad, es una-ri eqspresiul metyvelebaSi mowmdeba, rodesac bavSvs Txoven uazro sityvisaTvis Sesabamisi morfemis damate-bas. mag. `es aris gvarli. es ki ori cali gvarlia. eseni gvarlebia~. sxva SemTxvevaSi bavSvs Txoven winadadebis damTavrebas. mag. `ninos aqvs CanTa. es ninos. . . ., ninos wignebi. . . . daaqvs.~ receptuli (impresiuli) morfolo-giuri codnis Semowmeba receptuli sintaqsis testebis saSualebiT xdeba.

• pragmatika _ gulisxmobs enis gamoyenebas socialur kon-teqstSi pirovnebaTaSorisi urTierTobisas garkveuli miznebis misaRwevad. realur saubarSi winadadebis ga-moTqma gramatikis, morfologiis Tu semantikis swori gamoyenebis gamo ki ar xdeba, aramed sakuTari azris ga-mosaxatavad da mosaubreze gavlenis mosaxdenad. Setyo-binebis miRebis da Camoyalibebis unari SeiZleba damou-kideblad Sefasdes. bavSvebs pragmatuli unaris gansxva-vebuli profilebi aqvT. dReisaTvis mxolod ramdenime

�43

testiT fasdeba eqspresiuli da receptuli pragmatuli unarebi. farTo praqtika aqvs enis socialur konteqst-Si gamoyenebaze bunebrivi dakvirvebis meTods.

metyvelebis specifikuri ganviTarebis darRvevis zusti Sefaseba multidisciplinur midgomas moiTxovs, raTa sworad dadgindes pirveladi defeqtebis (simpto-mebis), maTTan dakavSirebuli meoradi simptomebisa da sindromTan dakavSirebuli sferoebis deficiti. marTa-lia, metyvelebis zemoaRweril darRvevas specifikurs uwodeben, magram igi mniSvnelovan gavlenas axdens bavS-vis fsiqikuri ganviTarebis mraval sferoze.

�44

metyvelebis testebis klasifikacia R. Paul-is (1997) mixedviT

testi

asak

i

Sesafasebeli sfero

eqspre-siuli

impre-siuli

fo

nol

og

ia

sema

ntik

a

sint

aqsi

fo

nol

og

ia

sema

ntik

a

sint

aqsi

prag

mat

ika

Assessment of Children’s Language Comprehen-sion (Foster, Gidden, Stank,1973)

3-7

Boehm Test of Basic Con-cepts (Boehm,1971)

5-7

Clinical Formulation of Language Functions (Semel, Wiig, 1980)

5-�8

Developmental Articula-tion Test (Hejne,1968)

all

Development Sentence Structure (Lee,1974)

�-7

Environmental Language Inventory (McDonald, 1978)

�-3

Expressive one world Picture Vocabulary Test (Gardner, 1979)E

3-��

�45

Evaluating Commu-nica-tive Competance (Si-mon,1984)

5-�8

Illinois Test of Psycholin-guistic Abilities(Kirk,Mc Carthy,Kirk,1968)

�-�0

Let’s talk Inventory for adolescents (Wiig, 1982)

9-adult

Fullerton Language Test for Adolescents(Thorum, 1980)

��-�8

Preschool Language Scale (Zimmerman, Stemer, 1969)

�-7

Test of Language Devel-opment-primery (New-comer, Hammill, 1988)

4-8

Peabody Picture Vocabu-lary Test (Dunn, Dunn, 1981)

�-adult

Test of Language Devel-opment -Interme-diate (Newcomer, Hammill, 1984)

8-�3

Sequenced Inventory of Communicative Deve-lop-ment (Prather, Tobin,1975)

0-4

Test of Auditory Com-prehension of Language -revised (Carrow-Woofolk,1985)

3-7

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ADHD– yuradRebis deficitisa dahiperaqtivobis sindromi

ra aris ADHD?

(ADHD) _ yuradRebis deficitisa da hiperaqtivobis sindromi warmoadgens centraluri nervuli sistemis fun-qcionirebis, anu neirobiologiuri darRveviT gamowveuli simptomebis erTobliobas, romelic moicavs:• yuradRebis koncentraciis deficits (uyuradReboba,

gonebagafantuloba); • impulsurobas (uneblie qcevis SeCerebisa da gakontro-

lebis sirTule); • hiperaqtivobas (motoruli mousvenroba, moZraobaTa

siWarbe), rasac xSirad erTvis emociuri moumwifebloba, agresiuloba da dabali akademiuri moswreba. Tu bavSvs skolaSi aqvs swavlisa da klaselebTan, maswavleblebTan urTierTobis problemebi, Tu igi ver axerxebs koncen-tracias saklaso oTaxSi, ar asrulebs da Tavs aridebs samuSaos _ SesaZloa, mas hqondes yuradRebis defici-tis da hiperaqtivobis sindromi. aseT bavSvebs xSirad `hiperaqtiurebs~ uwodeben, Tumca, cnobilia, rom zog SemTxvevaSi, yuradRebis problemebi, SeiZleba, damouki-deblad arsebobdnen impulsurobisa da hiperaqtivobis gareSe.ADHD-is sindromSi erTiandeba individebis ori jgufi:

pirveli jgufi _ yuradRebis deficitiT, hiperaqtivobis gareSe; meore jgufi _ yuradRebis deficitiT, impulsu-robiTa da hiperaqtivobiT. miuxedavad imisa, rom orive jgufis bavSvebis diagnozi erTi sindromiT aRiwereba, maT Soris mniSvnelovani klinikuri gansxvavebani arsebobs.

pirvel jgufSi gaerTianebuli bavSvebi xasiaTdebian rogorc ufro apaTiuri, meocnebe, inertuli, modunebu-li, zanti, morcxvi individebi; aqvT swavlis problemebi da maTi ojaxis istoriaSi xSiria swavlis problemebi Tu emociuri aSliloba;

meore jgufSi gaerTianebuli bavSvebi xasiaTdebian im-pulsurobiTa da Zlieri aqtiurobiT, mousvenrobiT, xSi-

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rad, agresiuli qceviT; skolis problemebidan SedarebiT xSiria qcevis problemebi. ojaxis istoria, umetesad, anti-socialuri problemebiTaa datvirTuli (narkomania, dam-naSaveoba). aseT bavSvebs antisocialuri qcevisa da cudi socialuri Seguebis didi riski aqvT (Hinshaw,1994). bavSve-bi, romelTac ADHD aqvT, gansxvavdebian simptomebis gamo-vlinebis xarisxiTa da intensivobiT. simptomTa mravalfe-rovnebisa da cvalebadobis gamo zusti diagnozis dadgena sakmaod rTuli procesia. ADHD-s gamovlenis specifika imaSi mdgomareobs, rom simptomebi TiTqmis SeumCnevelia an qreba axal, bavSvisaTvis saintereso situaciaSi, xSiri waxa-lisebis da intensiuri meTvalyureobis dros, erT adamian-Tan urTierTobisas. Sesabamisad, klinikuri dakvirvebis, testirebis procesSi SeiZleba es simptomebi SeumCneveli darCes. amitom mniSvnelovania mSoblebisa da maswavleble-bis informacia bavSvis qcevis Sesaxeb saxlisa da skolis garemoSi.

ADHD-s xSirad Tan axlavs emociuri aSliloba _ SfoTva da depresia. aseTi profilis mqone bavSvebSi sindromisTvis damaxasiaTebeli niSnebi gvian vlindeba. naklebad aReniS-nebaT sirTuleebi akademiur da kognitur sferoSi. stimu-lantebiT mkurnaloba maT SemTxvevaSi naklebefeqturia.

ADHD-is simptomebi, ZiriTadad, adreuli bavSvobidanaa SesamCnevi. Cvilobis asakidanve SeuZlebeli xdeba aseTi ba-vSvis qcevis winaswarmetyveleba. erT wuTs tiris da kivis, meore wuTs ki mSviddeba. igi xasiaTdeba gaRizianebulobiT, daZabulobiT, daukmayofileblobiT, momTxovnelobiTa da mousvenari ZiliT. siarulisa da metyvelebis ganviTareba Senelebulia. xSiria mouqneloba. aseTi bavSvebis naxevari ukve 3 wlis asakidan rTuli samarTavia. maT xSirad ecv-lebaT guneba-ganwyoba, Riziandebian, uWirT tualetis Cve-vebis aTviseba. magram, miuxedavad amisa, xSir SemTxvevaSi, mSoblebs ADHD-is simptomebi SeumCneveli rCebaT bavSvis skolaSi wasvlamde, radgan problemebi mTeli simZafriT swored am dros iCens Tavs. ADHD-is dadgenisaTvis opti-malur periodad miCneulia skolamdeli asaki da skolaSi yofnis pirveli weli (7 wlamde asaki).

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riTi xasiaTdeba ADHD?

miuxedavad imisa, rom ADHD-is mqone bavSvebi gansxva-vebul simptomebs amJRavneben, maTTvis yvelaze metad da-maxasiaTebelia uyuradReboba, ioli gadarTvadoba, dezor-ganizebuloba, impulsuroba, hiperaqtivoba. aseTi bavSvis qceva, ZiriTadad, Semdegnairad SeiZleba iRiweros:

• ar amTavrebs dawyebuls, erTi daumTavrebeli amocani-dan meoreze xteba;

• xSirad tovebs STabeWdilebas, rom sxvebs ar usmens;

• advilad efanteba yuradReba;

• uWirs koncentracia iseT davalebebze, romlebic mis interess ar iwvevs, mag. saSinao davaleba; maSin rode-sac, SeuZlia saaTobiT uyuros televizors, an iTamaSos kompiuterze;

• ver axerxebs samuSaos organizebas;

• xSirad icvlis saqmianobas;

• uWirs miTiTebis Sesruleba;

• saWiroebs mudmiv meTvalyureobas;

• xSirad kargavs nivTebs;

• ar SeuZlia lodini;

• ver emorCileba ganrigs;

• uWirs erT adgilze jdoma;

• xelebsa da fexebs mousvenrad amoZravebs, cqmutavs ska-mze;

• bevrs darbis, mousvenrobs;

• uWirs sakuTari jeris dalodeba;

• yovelTvis mzadaa gasaqcevad;

• xSirad umizezod tovebs merxs, saklaso oTaxs;

• moqmedebs daufiqreblad;

• ereva laparakSi da iWreba sxva bavSvebis TamaSis pro-cesSi;

• xSirad gadaWarbebulad bevrs laparakobs;

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• erTveba fizikurad saSiS qmedebebSi da ar fiqrobs Sede-gebze;

• zog SemTxvevaSi agresiulia da Semtevi.

aseT bavSvebs uWirT skolaSi swavla, aqvT socialuri da emociuri adaptaciis problemebi, radgan isini zedmetad mgrZnobiareni arian marcxisa da warumateblobis mimarT or yvelaze mniSvnelovan sferoSi _ swavlasa da urTier-TobebSi.

yvela am ZiriTadi simptomisaTvis damaxasiaTebelia si-tuaciuri sxvadasxvaoba; garkveuli situaciebi metad pro-blematuria ADHD-is mqone bavSvebisTvis. mag. yuradRebis deficiti xSirad iseT situaciebSi vlindeba, sadac ganmeo-rebadi, Cveuli, mosawyeni moqmedebebia saWiro. aseve, bav-Svi SeiZleba, zedmetad aqtiuri, agznebuli da mousvenari iyos situaciaSi, sadac mas koncentrireba da mowesrige-buloba moeTxoveba, jgufuri aqtivobebis dros, magram sawinaaRmdegod iqceodes Tavisufali TamaSis dros. amis gamo, ADHD-is mqone bavSvebi, SeiZleba, arc ki gansxvavde-bodnen Tanaklaselebisagan SedarebiT Tavisufal, naklebad struqturirebul garemoSi.

Tavad yuradRebis deficitisa da hiperaqtivobis sin-dromi (ADHD) gansxvavebulia sirTulis xarisxebis mixe-dviT. ganasxvaveben ADHD-s Semdeg formebs: • susti – umniSvnelod gamoxatuli simptomebi, aranairi,

an mxolod minimaluri CamorCena saskolo da sazoga-doebriv saqmianobaSi.

• saSualo – gamoxatulia simptomebi, an funqciuri CamorCena `sustsa~ da `mZime~ SemTxvevebs Soris.

• mZime – CamoTvlili simptomebis garda, vlindeba mra-vali sxva simptomic; mniSvnelovani da farTo speq-tris CamorCenaa saSinao, saskolo saqmianobasa da Tana-tolebTan urTierTobaSi.qvemoT moyvanilia DSM-IV-TR-isa da ICD-10-is saklasi-

fikacio sistemebSi ADHD-is mravalferovani sindromebis urTierTSesabamisoba, rac aadvilebs mdgomareobis identi-fikacias.

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ICD-10qceviTi da emociuri aSlilo-bebi, Ceveulebriv aRmocene-buli bavSvobis an mozardobis asakSi F90

DSM-IV-TRyuradRebis deficitisa da umarTavi qcevis aSlilobebi 314. XX

ara aqvs pirdapiri Sesatyvisi an F90.0 aqtivobisa da yura-dRebis darRveva an F90.8 sxva hiperkinetikuri darRveva

314.01 kombinirebuli tipi

F90.0 aqtivobisa da yuradRe-bis darRveva

314.00 upiratesad uy-uradRebo tipi

F90.1 qcevis hiperkinetikuri darRveva

314.01 upiratesad hipe-raqtiur-impulsuri tipi

F90.8 sxva hiperkinetikuri darRveva

F90.9 gaurkveveli hiperkine-tikuri darRveva

314.9 gaurkveveli tipi

ADHD-is klasifikacia da klinikuri niSnebi:

DSM-IV-TR, yuradRebis deficitisa hiperaqtivobis sindromia. qvemoT CamoTvlilidan eqvsi an meti simptomi unda vlin-debodes eqvsi Tvis ganmavlobaSi im xarisxiT, rom mocemu-li asakis bavSvs xels uSlides garemosTan SeguebaSi:uyuradReboba:• uWirs yuradRebis gamaxvileba detalebze, Secdomebs

uSvebs skolisa da saSinao samuSaoSi;• uWirs yuradRebis SenarCuneba davalebis Sesrulebis,

an TamaSis dros;• TiTqos ar gismenT, roca elaparakebiT;• xSirad ver axerxebs misdios da Seasrulos miTiTebebi; • uWirs skolisa Tu saSinao davalebis bolomde damTavreba;

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• uWirs davalebebisa da moqmedebis organizeba;

• Tavs aridebs da ar moswons iseTi davalebebi, sadac fsiqikuri Zalisxmevaa saWiro;

• xSirad kargavs nivTebs, rac davalebisaTvis an sxva aqtivobisaTvis esaWiroeba;

• gareSe stimulebiT Zalze advilad eSleba xeli;

• yoveldRiur cxovrebaSi Zalian gulmaviwyia;

b. eqvsi Tvis manZilze hiperaqtivoba-impulsurobis eqvsi an meti simptomi unda vlindebodes im xarisxiT, rom mocemu-li asakis bavSvs garemosTan SeguebaSi uSlides xels:

hiperaqtivoba:• xSirad cqmutavs da ver isvenebs;• xSirad tovebs sakuTar adgils klasSi, an sxvagan;• situaciisadmi Seusabamod darbis da Zvreba yvelgan;• sirTuleebi aqvs TamaSis da dasvenebis dros;• sul moZraobaSia, TiTqos mudmivi Zrava amoqmedebs;• xSirad da Zalian bevrs laparakobs;

impulsuroba:• pasuxs, xSirad,SekiTxvis damTavrebamde wamoiZaxebs;• uWirs sakuTari jeris dalodeba;• xSirad iWreba sxvebis aqtivobaSi, an awyvetinebs TamaSsa da saubars.g. uyuradRebobis an hiperaqtivoba-impulsurobis zogier-Ti simptomi 7 wlis asakamde vlindeba.d. am simptomebis umetesoba or an met sxvadasxva garemoSi vlindeba. mniSvnelovani klinikuri cvlilebebi warmoCindeba soci-alur, akademiur, SromiT aqtivobaSi da es sirTuleebi kav-SirSi araa sxva daavadebebTan.

gamosadiferencirebelia: upiratesad uyuradRebo tipi _ roca hiperaqtivoba ar vlindeba; upiratesad hipera-qtiur-impulsuri tipi _ roca uyuradRebobis simptomebi naklebad vlindeba.

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ICD-10, hiperkinetikuri darRvevakardinaluri niSnebia _ uyuradReboba da hiperaqti-

voba. diagnozisaTvis aucilebelia orive maTgani da orive unda vlindebodes erTze met situaciaSi.

darRveuli yuradReba vlindeba: davalebis bolomde

Sesrulebis sirTuleSi; bavSvi xteba erTi moqmedebidan meoreze, swrafad kargavs interess da gadainacvlebs sxva aqtivobaze;

am deficitis diagnostireba SesaZlebelia mxolod bav-Svis asakTan da IQ-sTan mimarTebaSi.

hiperaqtivoba gulisxmobs gadaWarbebul mousvenrobas: bavSvi bevrs darbis, daxtis, unebarTvod dgeba adgilidan, xmaurobs, gansakuTrebiT im situaciebSi, sadac mSvidad da Cumad yofnaa saWiro; es, SeiZleba, vlindebodes sxvadasxva garemoSi. laparakobs da ar Cerdeba, cqmutavs da igrixeba.

am deficitis diagnostika SesaZlebelia mxolod imave asakobrivi jgufis sxva bavSvebTan mimarTebaSi da IQ-s ga-TvaliswinebiT.

aRniSnuli qceviTi simptomebi gansakuTrebiT kargad Cans struqturirebul, organizebul situaciaSi, sadac qcevis TviTkontrolis maRali xarisxia saWiro.

darRvevisaTvis Cveuli qceviTi problemebi iwyeba eqvs wlamde asakSi da xangrZlivi istoria aqvs. misTvis damaxa-siaTebeli niSnebia: socialuri urTierTobis problemebi, socialuri wesebis impulsuri darRveva, daswavlis unaris darRveva, motoruli mouqneloba, saxifaTo situaciebSi gaufrTxilebloba;

hiperkinetikuri da qceviTi aSlilobis kriteriumi iseT SemTxvevebSi gamoiyeneba, rodesac am niSnebs emateba qceviTi aSlilobis maxasiaTeblebi.

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CBC (Achenbach)-is sistema, yuradRebis problemebis sin-dromiuyuradRebobis maCveneblebi:

• ar SeuZlia yuradRebis koncentracia;

• uyuradReboa skolaSi;

• aqvs swavlis sirTuleebi;

• aqvs skolaSi miTiTebebis Sesrulebis sirTule;

• uWirs saskolo samuSaos damTavreba;

• uWirs skolaSi davalebis Sesruleba;

• uwesrigod muSaobs gakveTilze;

• saskolo samuSaos cudad asrulebs;

• dabali miRweva aqvs skolaSi;

• skolaSi apaTiuria;

• dabneulia;

• meocnebea;

• icis miStereba;

hiperaqtivobis maCveneblebi:

• ar SeuZlia mSvidad jdoma;

• klasSi cqmutavs da moZraobs;

• mouxerxebelia;

• RiRinebs da ucnaur xmebs gamoscems gakveTilze, klasSi.

impulsurobis maCveneblebi:

• ver ikavebs impulss;

• nerviulia, daZabuli;

• moqmedebs sakuTar asakTan SedarebiT mcirewlovanis Sesabamisad.

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ADHD-is klinikuri niSnebi

sfero maxasiaTeblebi

SemecnebiTi yuradRebis xanmokle koncentracia;yuradRebis ioli gadatana;qcevis Sedegebis ganWvretis uunaroba;swavlis problemebi da dabali saskolo moswreba.

afeqturi impulsis kontrolis naklovaneba;swrafi agzneba, aRelveba;frustraciisadmi dabali tolerantoba;daqveiTebuli guneba-ganwyoba.dabali TviTSefaseba.

qceviTi aqtivobis maRali xarisxi;motorul ganviTarebaSi Seferxeba dacudi koordinacia;sarisko qcevebis ganxorcielebis maRali tendencia.

interperso-naluri Segueba

zogjer agresiuli, antisocialuri qce-vebis Tanxleba;problemebi mSoblebTan, maswavlebleb-Tan, tolebTan urTierTobaSi.

fizikuri mdgomareoba

Zvlovani qsovilis moumwifebloba da sxeulis fizikuri zrdis Seferxeba;minimaluri fizikuri anomaliebi; aler-gia;xSiri respiratoruli infeqciebi.

yuradRebis deficitis da hiperaqtivobis sindromis diagno-stirebisas aucilebelia diferencireba gakeTdes Semdeg mdgomareobebTan:

SfoTviTi aSliloba (F41; ICD-10)SfoTviTi aSliloba, gamowveuli bavSvobis asakSi ganSo-

rebis SiSisgan (F93.0; ICD-10)ganviTarebis pervesiuli aSliloba (F84; ICD-10)

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gonebrivi CamorCeniloba (F70-F79; ICD-10)medikamentozuri intoqsikaciiT gamowveuli impulsu-

robis, hiperaqtivobisa da uyuradRebobis simptomebi (IV ganzomileba: T36-50; ICD-10)

sensoruli integraciis darRveva.

amave dros, aRsaniSnavia, rom hiperaqtivobisa da yura-dRebis deficitis sindromTan komorbiduli mdgomareobe-bia depresia, SfoTviTi aSliloba, qceviTi aSliloba, opo-ziciur-devianturi qceviTi aSliloba, metyvelebis speci-fikuri darRvevebi da daswavlis unaris darRveva.

am SemTxvevaSi aucilebelia komorbiduli mdgomareobe-bis gamodiferencireba da orive diagnozis kodireba.

ra iwvevs ADHD-s?

ADHD-is raime konkretuli gamomwvevi mizezi ar arse-bobs. mkvlevrebi cdiloben, misi ganviTareba genetikur, bioqimiur, neirobiologiur da garemos faqtorebs daukav-Siron. erT-erTi modeli (Kenn, �980) warmodgenilia Svidi urTierTmoqmedi komponentiT:

• genetikuri midrekileba;

• ganviTarebaSi CamorCena;

• saSualoze dabali inteleqtualuri da socialuri una-rebi;

• azrovnebis specifikuri problemebi;

• araxelsayreli garemo (dRenakluloba, sakvebis nakle-boba, mwiri socialuri daxmareba);

• emociuri problemebi da rTuli damokidebulebebi ojaxSi.

ganarCeven ADHD-s biologiur, intrafsiqikur da fsi-qosocialur etiologiur Teoriebs.

♦ biologiuri Teoriebi.genetikuri hipoTeza - ADHD-is sindromis gamomwvevi

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genetikuri komponenti Seiswavles tyupebisa da naSvilebi bavSvebis SemTxvevaSi. aRmoCnda, rom erTkvercxujrediani ganayofierebiT dabadebuli tyupebs ufro xSirad hqondaT ADHD-s damaxasiaTebeli erTnairi simptomebi, orkvercxu-jrediani ganayofierebiT dabadebuli tyupebisgan gansx-vavebiT. ADHD ufro xSiria mkvidr da-ZmaSi, vidre naxevar da-Zmas Soris. aseve, aRmoCnda, rom hiperaqtiuri bavSvebis biologiur mSoblebSi xSiria fsiqiuri aSliloba, nevro-zebi, TviTmkvlelobis SemTxvevebi, alkoholizmi. geneti-kurma kvlevebma daadgina, rom ADHD -is mqone bavSvebis na-Tesavebidan es sindromi, ufro xSirad, mamrobiTi sqesSi gvxvdeba (biZaSvil-mamidaSvilebSi, biZaSvil-mamidaSvilebis SvilebSi), rac adasturebs ADHD-is sindromis genetikurad gadacemis Sesaxeb arsebul mosazrebas. organuli deficitis Teoriis mixedviT, yuradRebis,

impulsuri qcevis, hiperaqtivobis meqanizmebi da maTi darRvevebi, SeiZleba, ganxilul iqnas neiroanatomiuri, neiroqimiuri da neirofiziologiuri TvalTaxedviT.

neiroanatomiuri mizezebis dadgena gulisxmobs tvinis im ubnebis gamokvlevas, romlebic uzrunvelyofs yura-dRebasa da stimulze motorul reagirebas. arsebobs mosazrebebi, rom ADHD-is mqone pirebs:

darRveuli aqvT Sua tvinis struqturebis (Talamusi da hipoTalamusi) funqcioba.

• aReniSnebaT retikuluri formaciisa da limburi stru-qturebis funqciobis dabali done (Tumca, es mosazre-bebi Semdgom damtkicebas moiTxovs).

• aReniSnebaT Sublis wilebis funqciobis deficiti (Wag-ner, 2000).gavrcelebuli iyo mosazreba, rom ADHD-is sindromi

warmoadgens organuli deficitis, kerZod, tvinis minimal-uri disfunqciis Sedegs. ADHD-is mqone bavSvebSi neirovi-zualurma gamokvlevebma Tavis tvinis raime specifikuri struqturuli anomaliebis arseboba ar daadastura; nei-rofsiqologiurma kvlevebma ki ver gamoavlina kognituri deficitis raime unikaluri paternis arseboba, romelic mi-aniSnebda Tavis tvinis difuzur Tu lokalur dazianebaze. amave dros, pre- da perinatalur periodSi nayofze mavne

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zemoqmedebis faqtorebi (rogoricaa Tambaqosa da alko-holis moxmareba orsulobis periodSi, dabadebisas bavSvis mcire wona da Tavis garSemoweriloba, tyviiT mowamvla), romlebic ara mxolod ADHD-is, aramed sxva paTologiuri mdgomareobebis aRmocenebasac uwyobs xels, sakmaod xSiri iyo ADHD-is mqone bavSvebis istoriaSi.

neirotransmiteruli regulaciis Teoria. neiroqimiuri faqtorebis kvleva gulisxmobs yuradRebis procesSi Car-Tuli specifikuri nervuli gadamcemebis _ neirotransmi-terebis funqcionirebis, ZiriTadad, monoaminuri metabo-lizmis donis Seswavlas. ADHD-is SemTxvevaSi, pirvel rigSi, irRveva kateqolaminebis _ dofaminisa da norepinefrinis cvla: dofaminuri sistemis disfunqcia vlindeba ventral-uri tegmentumis areSi (Sua tvinis saxuravi), xolo nor-adrenalinis deficiti _ cisfer birTvSi (meoTxe parkuWis midamoSi). hiperaqtiur bavSvebSi aRmoCenilia serotoninis dabali donec. am sistemebis funqciobis disbalansi iwvevs agzneba–Sekavebis meqanizmebis darRvevasa da yuradRebis meqanizmebis Sesustebas. aseve, mniSvnelovania ganisazRv-ros is funqcionaluri sistemebi, romlebic uzrunvelyofs yuradRebis regulacias, SerCeviTobas da kontrols. mag. bioqimiuri analizi gviCvenebs im neirotransmiterebis garkveuli deficitis arsebobas, romlebic motoruli mza-obisa da kontrolis sistemebTan aris dakavSirebuli.

qveagznebis hipoTeza. am Teoriis mixedviT uyuradRe-bobisa da hiperaqtivobis sindromi gamowveulia sasignalo stimulis SenarCunebisa da aqtivobis donis regulaciisaT-vis saWiro agznebis arasakmarisi doniT. fsiqofiziologi-uri gamokvlevebiT aRmoCnda, rom ADHD-is mqone bavSvebs daqveiTebuli aqvT fsiqofiziologiuri reagireba axal sasignalo stimulze (eeg-s, kanis galvanometruli maCvene-blebis, guliscemis sixSiris mixedviT). amasTan, gasaTval-iswinebelia, rom axal sasignalo stimulze reagirebis daqveiTeba, SeiZleba, gaaCndeT daswavlis unaris darRvevi-sa da qceviTi aSlilobis mqone bavSvebsac.

alergiis hipoTeza. am Teoriis mixedviT ADHD-is mize-zebi kvebasa da kvebiT CvevebSi unda veZeboT. Feingold (�975) amtkicebda, rom kvebis xelovnuri danamatebi (ferisa da

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gemos emulgatorebi Tu konservantebi) mniSvnelovnad uw-yobs xels ADHD-is simptomebis aRmocenebas. Tumca, kon-trolirebuli gamokvlevebiT es hipoTeza ver dadastur-da. Egger-ma (�985) daadgina, rom ADHD-is mqone bavSvebs specifikuri alergiuli profilebi aqvT da Tu moxdeba maTi dietis regulireba an alergiuli agentebis kvebidan amoReba, maTi uyuradRebobisa Tu impulsurobis simptome-bi Semcirdeba. es Teoria dadasturebul iqna ADHD-s mqone bavSvebis kontrolirebuli dietologiuri kvlevebiT. aqe-dan gamomdinare, aRniSnuli sindromis mqone bavSvebis kve-basa da alergiuli profilis kontrols mniSvnelovani yu-radReba unda mieqces. rekomendebulia: naturaluri bost-neuli, xili, Saqrisa da burRuleulis iSviaTad gamoyeneba, xelovnuri danamatebisagan Tavisufali produqti.♦ intrafsiqikuri Teoriebi

uyuradRebobis hipoTeza gulisxmobs, rom ADHD-is simptomebs safuZvlad udevs yuradRebis erT moqmedebaze SenarCunebis problema. davalebis Sesrulebis dasawyisSi am sindromis mqone bavSvebi ar gansxvavdebian sxva bavSvebisgan, garkveuli drois Semdeg ki isini iwyeben Secdomebis daSve-bas. yuradRebis SenarCunebis problemis gamo, bavSvi iZule-bulia xSirad Secvalos yuradRebis fokusi, rac iwvevs qce-vis impulsurobasa da hiperaqtivobas. amave dros, gamokv-levebis safuZvelze aRmoCnda, rom yuradRebis SenarCunebis deficiti, TavisTavad, ver gamoiwvevs ADHD sindroms.

ADHD sindromis ZiriTad meqanizmad, zogierT spe-cialists yuradRebis SerCeviTobis darRveva miaCnia. yu-radRebis SerCeviToba, seleqciis unari gulisxmobs cen-traluri nervuli sistemis maRali donis aqtivaciis da sifxizlis SenarCunebas relevantur gamRizianeblebze cnobierebis garkveuli periodiT SeCerebisas. yuradRebis SerCeviTobis procesebis safuZvelzea SesaZlebeli irele-vanturi gamRizianeblebis ignorireba da qcevisaTvis Sesa-tyvis gamRizianeblebze koncentrireba. es unari darRveu-lia ADHD sindromis SemTxvevaSi (Levine, 1994).

hiperaqtivobis hipoTeza amtkicebs, rom motoruli aq-tivobis Sekavebis centraluri deficiti ADHD-isTvis dam-axasiaTebeli ZiriTadi defeqtia, romelic iwvevs uyur-

�59

adRebobasa da hiperaqtivobas.impulsurobis hipoTeza gulisxmobs, rom ADHD-is gan-

viTarebis ZiriTad mizezs specifikuri stimulebisadmi kognituri da qceviTi reagirebis centraluri Sekavebis defeqti warmoadgens. am Teoriis mixedviT akademiur aq-tivobaSi, romelic moiTxovs nebismieri yuradRebis Senar-Cunebis maRal xarisxs, ADHD-is mqone bavSvebi problemis gadawyvetis strategiebis gamoyenebis sirTuleebs awydebi-an. am sirTules safuZvlad udevs moqmedebis dagegmvis, mimdinare moqmedebis Sefasebisa da misi kontrolis pro-cesebis deficiti. bavSvs uWirs ukukavSiris gamoyeneba da mimdinare moqmedebisas Secdomebis kontroli, aseve prob-lemas warmoadgens sxvebis mxridan micemuli ukukavSiris gamoyeneba ((Levine, 1998).

wesebis dacvis deficitis hipoTeza. Berkley (�98�) Tv-lis, rom ADHD-is problemas wesebis dacvis siZnele war-moadgens. es deficiti metyvelebis garegani da Sinagani maregulirebeli funqciis darRvevasTanaa dakavSirebuli. ADHD-is mqone bavSvebSi xSiria metyvelebis ganviTarebis Seferxeba. amitom maTTvis unda Seiqmnas TviTkontrolisa da TviT-instruqtirebis kognitur-qceviTi treningis spe-cialuri programebi.♦ fsiqosocialuri Teoriebi

sistemebis Teoria. fsiqosocialuri Teoriebi ADHD-is aRmocenebaSi ZiriTad yuradRebas amaxvilebs ojaxis, an ufro farTo socialuri garemos rolze. ojaxuri prob-lemebidan aRsaniSnavia: mSoblebis fsiqologiuri prob-lemebi (depresia, SfoTva, agresia, alkoholizmi, narkoma-nia), col-qmruli uTanxmoebani, mSoblis da bavSvis Zalado-brivi urTierTobebi, CvilobaSi zedmeti mzrunveloba. farTo speqtris socialuri konteqstidan mniSvnelovania: dabali socialur-ekonomiuri statusi, institucional-izacia, TanatolebTan urTierTobis problemebi, skolis personalTan urTierTobis problemebi. unda aRiniSnos, rom es problemebi, ufro metad, qceviTi aSlilobis risk-faqtorebia da ara ADHD-is ganviTarebisa.

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ramdenad xSiria ADHD?

ADHD-is gavrceleba gansxvavdeba qveynebis socialur-ekonomikuri mdgomareobebis mixedviT, Tumca, socialuri mdgomareobis miuxedavad, garkveuli xarisxiT gvxvdeba yvela qveyanasa da kulturaSi. gamokvlevebis Tanaxmad, igi saskolo asakis bavSvebis 3-7%-s aReniSneba. amasTan, misi SemTxvevebi biWebSi ufro xSiria: biWebis Sefardeba go-gonebTan meryeobs 6:�-dan �0:�-mde. sayuradReboa is faqti, rom diagnostikuri kriteriumebis mixedviT Sefasebisas, gogonebSi xSiria yuradrebis deficitisa da hiperaqtivo-bis sindromis upiratesad uyuradRebo tipi, romlis qcev-iTi gamovlinebebi naklebad SesamCnevia. generalur popu-laciaSi ADHD-s diagnostikur kriteriumebs, saSualod, mamakacebis 9%, xolo qalebis 4% akmayofilebs.

ra ZiriTadi problemebi gvxvdeba ADHD-is SemTxvevaSi?

am sindromis ZiriTadi problemebia yuradRebis defici-ti, impulsuroba da hiperaqtivoba. maTTan dakavSirebuli sirTuleebia:• CamorCena akademiur moswrebaSi;• problemebi TanatolebTan urTierTobaSi;• dabali TviTSefaseba da upativcemuloba sakuTari Ta-

vis mimarT;• qcevis problemebi;• negatiuri damokidebuleba mSoblebTan;• negatiuri damokidebuleba maswavleblebTan;• agresiuloba. yuradRebis deficiti vlindeba:• TanatolebTan SedarebiT yuradRebis koncentraciis

unaris xangrZlivobis simcireSi; • yuradRebis SerCeviTobisa da fokusirebis darRvevaSi;

seleqciuri yuradRebis simwireSi, stimulebis aRqmisa da gagebis SezRudul unarSi;

• xelisSemSleli stimulisadmi zedmetad mgrZnobiarobaSi:

�6�

aseT bavSvebs yuradReba Zalze advilad gadaaqvT xelis-SemSlel stimulebze; maT ar SeuZliaT impulsuri reaq-ciis SeCereba iseT situaciaSi, romelic moiTxovs koncen-trirebul, organizebul da mizanmimarTul moqmedebas;

• yuradRebis mizanmimarTuli gadatanis unaris daqveiTebaSi.es yovelive imiT aixsneba, rom aseT bavSvebSi Zalian da-

balia aqtivaciis done da amitom isini stimulirebis sxva wyaroebs eZeben. tvinis aqtivobis done hiperaqtiur bavSve-bSi gacilebiT ufro dabalia, vidre Cveulebriv bavSvebSi.impulsuroba vlindeba:• davalebaze pasuxis gacemisas, SeCerebis da dafiqrebis

uunarobaSi; • sakuTari jeris dalodebis uunarobaSi;• Tanmimdevruli moqmedebis dagegmvisa da kontrolis

problemebSi;• daufiqrebel moqmedebaSi.

hiperaqtivoba vlindeba Warb motorul aqtivobaSi. aqti-vobis xarisxis gasazomi specialuri xelsawyoebis saSuale-biT miRebuli Sedegebi miuTiTebs imaze, rom ADHD-is mqone bavSvebi, sxva bavSvebTan SedarebiT, mousvenrobis maRali doniT xasiaTdebian. aqtiurobis zrda naklebad SesamCnevia Tavisufali TamaSis dros, magram aSkara xdeba wesebiT Sez-Ruduli TamaSebis, filmebis yurebis, an konstruqtoriT TamaSis dros. unda aRiniSnos, rom zog SemTxvevaSi aqti-vobis donis gazomvebis Sedegebi hiperaqtiur jgufSi ar emTxveva yuradRebis gazomvis Sedegebs. aucilebeli araa, rom uyuradRebo bavSvebi zedmetad mousvenrebi iyvnen. Se-sabamisad, ADHD-is mqone bavSvebi gansxvavdebian qceviTi simptomebis mixedviT.

CamorCena akademiur moswrebaSi _ pirvel meore klasSi ADHD-is mqone bavSvebis akademiuri moswrebis Sefasebis monacemebi (inteleqtis koeficientis maCveneblebi, miRw-evis testebis monacemebi) ar gansxvavdeba imave asakis Cveu-lebrivi bavSvebis monacemebisgan; me-3 klasidan ki maTi maCveneblebi gacilebiT dabali da cvalebadia normasTan SedarebiT. damtkicebulia, rom mcirewlovan bavSvebTan Se-darebiT ufrosi asakis ADHD-is mqone bavSvebs meti prob-lemebi uCndebaT swavlasa da emociur ganviTarebaSi. isini,

�6�

patarebTan SedarebiT, ufro depresiulni da agresiul-ni arian, uWirT komunikacia. aRsaniSnavia, rom agresiul ADHD-is mqone bavSvebs gacilebiT metad uWirT kiTxvis swavla, vidre ubralod agresiul, an mxolod ADHD-is mqone bavSvebs.

agresiuloba da qcevis problemebi _ ADHD-is mqone bavSvebs uWirT socialuri urTierTobebis damyareba. isini xSirad arapopularulebi da gariyulebi arian Tanatolebis mier. gasakviri araa, rom maTi umetesoba ar aris darwmuneb-uli sakuTar SesaZleblobebSi da TiTqmis dakarguli aqvs TviTpativiscema. asakis matebasTan erTad es problemebi mZafrdeba. ADHD-is mizeziT gamowveuli yvelaze mniS-vnelovani problemaa agresiuli da asocialuri qceva (mag. Cxubi, qurdoba, tyuili). msgavsi qcevebi ADHD-is mqone bavSvebis 70%-s axasiaTebs. gasagebia, rom problemuri qce-vis gamo aseTi bavSvebis mimarT uaryofiTi ganwyoba iqmne-ba, mis mimarT negatiuri damokidebulebaa saxlSi, skolaSi. amitomaa, rom xSirad qcevis problemebis mogvareba ADHD-is gankurnebasTan asocirdeba.

rogor SeiZleba davexmaroT ADHD-is mqone bavSvs?

pirvel rigSi aucilebelia sindromis diagnostika da swori Sefaseba. imis gamo, rom ADHD-is gamovlinebebi mra-valferovania, sxvadasxva situaciaSi gansxvavebulad vlin-deba, uSualo dakvirvebasTan erTad metad mniSvnelovania informaciis sxvadasxva wyarodan mogroveba. diagnostiki-saTvis aucilebelia imis garkveva, Tu ramdenad eTanxmeba qceviTi gamovlinebebi ADHD-is diagnostikur kriteriume-bs, ra sixSiriT da romel situaciebSi aRmocendeba pro-blemuri qcevebi da ra xarsixiT uSlis es qcevebi bavSvs yo-veldRiur funqcionirebasa da garemosTan SeguebaSi, aseve, aqvs Tu ara bavSvs sxva Tanmxlebi aSliloba. swori diagnostikisaTvis saWiroa: �. mSoblis interviureba saxlSi bavSvis qcevasTan dakav-

SirebiT;

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�. maswavleblis interviureba klasSi bavSvis qcevis Sesaxeb;3. bavSvis fsiqologiuri testireba inteleqtis donisa da

fsiqikuri funqciebis asakobrivi momwifebis dadgenis mizniT;

4. bavSvze uSualo dakvirveba, romlis drosac fasdeba bavSvis impulsurobis, hiperaqtivobisa da uyuradRebo-bis qceviTi gamovlinebebi da maTi xarisxi;

5. bavSvis mdgomareobis Sefaseba komorbiduli aSlilo-bebis gamovlenis mizniT da diferencirebuli diagnos-tikisaTvis: aucilebelia bavSvis SfoTviTi aSlilobis, depresiis, qceviTi aSlilobis, opoziciur-devianturi qcevis, ganviTarebis pervesiuli aSlilobisaTvis dam-axasiaTebeli kriteriumebis Semowmeba.

ADHD-is mkurnaloba da simptomebis Semsubuqeba maqsi-malurad efeqturia maSin, rodesac gamoiyeneba sxvadasxva saxis midgomebi.• upirveles yovlisa, mSoblebi maqsimalurad unda iyvnen

informirebulni ADHD-is Sesaxeb, raTa adekvaturi damokidebuleba CamouyalibdeT bavSvis mdgomareobis Sesaxeb, SeZlon sworad gansazRvron da daakvirdnen simptomebs;

• bavSvisaTvis, mizanSewonilia, individuri, an jgufu-ri konsultaciebis Catareba. konsultacia SeiZleba moicavdes: ADHD-is Sesaxeb informirebas; socialuri urTierTobis Cvevebis Camoyalibebis trenings; special-uri teqnikebis swavlebas, romlebic bavSvs daexmarebi-an impulsis Sekavebasa da yuradRebis koncentraciaSi. mozrdil bavSvebs davalebisa Tu samuSaos organizebasa da dasrulebas aswavlian dRiurebis da wamzomis gamoy-enebiTac ki.

• mSoblebisa da maswavleblebis mier qceviTi teqnikis gamoyeneba, daexmareba bavSvs warmatebiT Sexvdes gare-mos moTxovnebs. rogorc aRmoCnda, ADHD-is mqone bavS-vebis umravlesoba miiswrafvis sxvebisTvis mosawoni qcevisaken, davalebis warmatebiT dasrulebisaken, ami-tom winaswar SeTanxmebuli araverbaluri signali, Sei-Zleba, Zalian sasargeblo gamodges davalebasTan dasa-

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bruneblad. davalebis damTavrebisa da miTiTebis Ses-rulebis SemTxvevaSi, waxaliseba (prizi, jildo, Seqeba) sasargebloa am miRwevebis ganmtkicebaSi. es dadebiTi ganmtkiceba drouli da xSiri unda iyos. ADHD-is mqone bavSvebi ar reagireben gadavadebul waxalisebasaze. skolamdeli asakis bavSvebisTvis waxaliseba yovel 5-�0 wuTSia saWiro. dawyebiTi skolis asakis bavSvebisTvis dReSi ramdenjerme, mozrdilebisTvis – dReSi erTx-el.ADHD-is mqone bavSvebis dasaxmareblad sxva xerxebic

gamoiyeneba:

• bavSvisTvis mxolod erT an or-nabijiani davalebis micema.

• saSinao davalebis mcire davalebebad dayofa (TiToeu-li patara davaleba mowmdeba axal davalebaze gadasv-lamde).

• bavSvisaTvis Cveneba, Tu ra raodenobis davalebebis dasruleba SeuZlia winaswar gansazRvruli drois gan-mavlobaSi.

• bavSvisaTvis dRiuris warmoebaSi daxmarebis aRmoCena.

• saSinao davalebis rveulSi dRis ganrigis gegmis saxiT Camowera da misi Semowmebis swavleba.ADHD-s mqone bavSvebis dasaxmareblad farTod gamoiy-

eneba ojaxuri intervenciis programa: ♦ pirveli Sexvedra fsiqo-saganmanaTlebloa: mSoblebs

ADHD-is Sesaxeb amomwuravi informacia miewodebaT maTTvis gasagebi eniT.

♦ meore Sexvedrisas xdeba bavSvi-mSoblis urTierTo-bis oTx faqtoriani modelis aRwera da qcevis marT-vis principebis ganxilva. bavSvis qceva aixsneba Semdegi oTxi faqtoris moqmedebis efeqtiT:

�. bavSvis Sinagani maxasiaTeblebi, rogoricaa tempe-ramenti;

�. mSoblis Sinagani maxasiaTeblebi;

3. ojaxuri stresi;

4. bavSvis qcevis uSualo Sedegebi.

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am Sexvedraze xdeba ganmtkicebis sistemebis gacnoba. mSoblebis qcevac am oTxi faqtoriT ganisazRvreba. bavSvis qcevaze mSoblis reagirebis xasiaTze gavlenas axdens:

�. mSoblis Sinagani maxasiaTeblebi _ maTi molodinebi;

�. bavSvis Sinagani maxasiaTeblebi;

3. ojaxuri stresi;

4. ufrosis qcevis Sedegebi.

iseve, rogorc mSoblebi axdenen gavlenas da ayalibeben ba-vSvis qcevas, bavSvebic moqmedeben mSoblebis qcevaze. am Sexve-draze ganixilaven bavSvis mSobelze zemoqmedebis meqanizmebs.♦ mesame Sexvedraze mSoblebs avarjiSeben bavSvTan specia-

luri TamaSis procesSi pozitiurad upasuxon socia-lurad misaReb qcevas da ignorireba gaukeTon arasa-survel qcevas. specialuri TamaSisTvis yoveldRiurad unda iqnas gamoyofili, daaxloebiT, �5-�0 wuTi. bavSvi TviTon irCevs raime aqtivobas. bavSvTan urTierTobisas mSobeli unda moeridos brZanebebsa da SekiTxvebs. mSo-beli aRniSnavs bavSvis dadebiT aqtivobas da ajildo-vebs mas. amave dros, xdeba miuRebeli qcevis ignorire-ba. rogorc ki urTierTobis aseTi stili Camoyalibdeba, bavSvi nel-nela erTveba aseTi tipis urTierTobaSi da misTvis mSobelTan urTierToba Rirebuli xdeba.

♦ meoTxe Sexvedrisas mSoblebs avarjiSeben, Tu rogor miiRos socialurad misaRebi qceva da rogor gaukeTos ignorireba miuRebel qcevas, maSin, roca bavSvi damouki-deblad TamaSobs. ZiriTadi Cvevaa misi socialurad misaRebi qcevis aRniSvna da ganmtkiceba. am Sexvedra-ze msjeloben bavSvisaTvis efeqturi miTiTebebis mi-cemaze. bavSvisadmi mimarTuli instruqciebi unda iyos mokle, martivi, gasagebi; gamoTqmis toni ki unda iyos iseTi, rom gamoxatavdes darwmunebulobas maT Sesru-lebaSi. instruqciis micemisas aucilebelia TvalebiT kontaqti. miTiTebis micemisas Semafasebeli informacia sasurveli ar aris, radgan arTulebs aRqmas da iwvevs bavSvis winaaRmdegobas. miTiTebis micemis Semdeg, sa-survelia, bavSvma gaimeoros davaleba, saidanac Cans, gaigo Tu ara man miTiTeba.

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rodesac miTiTebebis Sesrulebis trenings iwyeben, mi-zanSewonilia iseTi aqtivobebiTa da davalebebiT dawyeba, romelSic bavSvi ufro met mondomebasa da interess amJRa-vnebs. varjiSisaTvis aucilebelia iseTi droisa da adgilis SerCeva, rom bavSvi ar iyos daRlili, avad, an xmaurian ga-remoSi. Sexvedris bolos mSoblebs aZleven saSinao dava-lebas bavSvisaTvis dadebiTi ganmtkicebisa da ignorirebis moqmedebebis ganxorcielebaSi.♦ mexuTe Sexvedraze mSoblebi varjiSoben, Tu rogor da

ra saxiT gamoiyenon dajildoeba.samkurnalo programis dawyebidan me-6 _ me-8 kvirisa-

Tvis wesrigdeba bavSvisa da mSoblis urTierToba. amitom:♦ meeqvse Sexvedraze mSoblebs aswavlian, Tu rogor unda

ganaxorcielon uaryofiTi ganmtkiceba da dasjis ra formebi unda gamoiyenon wesebis darRvevisa Tu urCo-bis epizodebis SemTxvevaSi.

♦ meSvide Sexvedraze mSoblebs aswavlian “taim-autis” principebs da konkretul SemTxvevaSi maTi gamoyenebis xerxebs.

♦ merve Sexvedrisas mSoblebs aswavlian, Tu rogor gau-mklavdnen bavSvis miuRebel qcevas sazogadoebriv ad-gilebSi; avarjiSeben rogor ganWvriton problema da Tavidan aicilon arasasurveli qceva.es programa sakmaod moqnilia da advilad xorciel-

deba. mSoblebs eZlevaT dabeWdili masalebi da damxmare instruqciebi (Barkley, �987; Carr, 1997). Tu mSoblebs raime sirTuleebi aqvT bavSvTan urTierTobisas, isini telefo-niT ukavSirdebian Terapevts (fsiqologs) da iReben kon-sultacias.

rogor vaswavloT ADHD-is mqone bavSvs?

ADHD-is mqone bavSvebs, pirvel rigSi, esaWiroebaT swa-vlis fizikuri pirobebis Seqmna, Semdeg, specialuri saswa-vlo programebi, romelebic aseTi bavSvebis Taviseburebebs iTvaliswinebs.

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fizikuri garemos mowyoba:�. sasurvelia da aucilebelic, daxuruli tipis saklaso

oTaxebi, vinaidan Ria tipis oTaxebSi mravali smeniTi da mxedvelobiTi xelSemSleli stimulia.

�. umjobesia, bavSvi davsvaT pirvel merxze, maswavle-belTan axlos, karebisa da fanjrebisgan moSorebiT.

3. yoveli gare xmauri da mxedvelobiTi gamRizianebeli minimumamde unda iqnas dayvanili, gansakuTrebiT maSin, rodesac axali masalis miwodeba xdeba.

miTiTebebi:4. miTiTebebi bavSvs unda miewodos martivi winadadebe-

biT, swori artikulaciiT, mkafiod. 5. miTiTeba unda iyos konkretuli, pozitiurad formu-

lirebuli; kerZod, mokle Setyobineba imis Sesaxeb, Tu ra unda gaakeTos bavSvma.

6. axali informacia unda danawevrdes mokle Temebad.7. zepiri informaciis ukeT gagebas xels uwyobs maswavle-

blis mier neli tempiT saubari.8. verbalur miTiTebebs Tan unda axldes vizualuri, da-

mxmare masala (suraTebi, diagramebi, modelebi.)9. vinaidan yofiTi movlenebi ukeTesad gvamaxsovrdeba,

konkretuli magaliTebi da uSualo gamocdilebiT mi-Rebuli codna metad efeqturia.

�0. aucilebelia bavSvTan perioduli ukukavSiris damyare-ba imaSi dasarwmuneblad, rom igi namdvilad gvismens. am dros maswavlebeli TvalebiT kontaqts amyarebs bavSvTan da mSvidad aZlevs kiTxvas gansaxilveli sakiTxis Sesaxeb.

��. saWiroebis SemTxvevaSi aucilebelia miTiTebebis gameore-ba; saWiroa bavSvis gamxneveba, raTa gaimeoros miTiTeba.

qcevis marTva:��. aucilebelia bavSvisTvis struqturirebuli garemos

Seqmna, sadac man icis Tu ras moelodebian misgan. we-sebi unda iyos martivi, cota da bavSvebTan winaswar Se-Tanxmebuli. bavSvma zustad unda icodes Tu rogori iqneba maswavleblis reagireba wesis darRvevaze an mis warmatebaze.

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�3. mniSvnelovania saklaso rutinis SemuSaveba, radgan bavSvisTvis garemo, ufrosis qceva unda iyos konsis-tenturi da mosalodneli.

�4. maswavlebeli yovelTvis warmarTavs bavSvis yuradRe-bas sityviT, fizikuri SexebiT da e.w. `saidumlo~ signa-lis gamoyenebiT. bavSvisaTvis ar aris sakmarisi mxolod sityviT Sexseneba, an SeniSvna. aucilebelia reagirebis ramdenime formis erTdrouli gamoyeneba.

�5. aucilebelia bavSvis qcevis Sedegze dauyovnebliv re-agireba. bavSvs esaWiroeba xSiri, mkafio da gasagebi ukukavSiri mis qcevaze.

�6. qcevis garedan dagegmva da miTiTebebi imis Sesaxeb Tu ra ris Semdeg unda gaakeTos, xels uwyobs bavSvis mizan-Sewonil qcevas gakveTilze.

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autizmi

ra aris autizmi?autizmi tvinis ganviTarebis neirobiologiuri darRvevis

Sedegia, rac mniSvnelovan gavlenas axdens bavSvis verbal-uri da araverbaluri komunikaciis damyarebis, socialuri urTierTobebis Camoyalibebisa da gonebrivi ganviTarebis procesebze. bavSvs problemebi aqvs socialur ganviTare-baSi, komunikaciaSi, metyvelebaSi, qcevaSi, gansakuTrebiT ki warmosaxviT TamaSSi. pirvelad autizmi �943 wels aRwera Leo Kanner-ma adreuli bavSvobis autizmis saxelwodebiT. igi gamoyofda autizmisaTvis damaxasiaTebel Semdeg niSnebs:

• socialuri urTierTobis damyarebis uunaroba,

• komunikaciis mizniT metyvelebis gamoyenebis SeuZle-bloba,

• cvlilebebisadmi Zlieri rezistentoba,

• sagnebiT gataceba,

• am maxasiaTeblebis gamomJRavneba 30 Tvis asakamde.

autizmis simptomebi, Cveulebriv, Tavs iCens bavSvis cxovrebis pirveli sami wlis ganmavlobaSi da Tan sdevs mas mTeli cxovrebis manZilze. sayuradReboa, rom SemTxvevaTa �0%-Si mSoblebi aRniSnaven normalur ganviTarebas pirve-li ori wlis ganmavlobaSi.

gamovlinebis xarisxis mixedviT autizmi mravalferova-nia. yvelaze Zlier formas axasiaTebs garemosTan kontaqtis SeuZlebloba, TanatolebTan da ufrosebTan urTierTobis damyarebis SeuZlebloba, interesebis, emociis gaziarebis SeuZlebloba, ganmeorebadi, uCveulo, TviTdamazianebeli da agresiuli qceva, SiSebi. yvelaze susti forma hgavs pirovnul aSlilobas, daswavlis unaris darRvevas.

autizmis mqone bavSvebs iSviaTad Tu SeuZliaT icxovron intensiuri da xangrZlivi Terapiuli intervenciis, mSo-blebis zrunvisa da zogjer hospitalizaciis an mkurnalo-bis gareSe.

autizmis sindromisaTvis damaxasiaTebli niSnebi sxva

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mdgomareobebis drosac gvxvdeba, amdenad, dgeba diagnos-tikuri kriteriumebisa da autizmis msgavsi mdgomareobebis klasifikaciis problema.

sinonimebia: bavSvTa autizmi, kaneris sindromi, adreu-li bavSvobis autizmi.

ganviTarebis perversiuli aSlilobis klasifikacia

ICD-10 DSM-IV-TR

F84.0 bavSvTa autizmi 299.0 autisturi aSliloba

F84.1 atipuri autizmi

F84.2 retis sindromi 299.80 retis aSliloba

F84.3 bavSvobis sxva dezinte-graciuli aSliloba

299.10 bavSvobis dezintegraciuli aSliloba

F84.4 zeaqtiuri aSliloba gone-brivi CamorCenilobiTa da ste-reotipuli moZraobebiT

F84.5 aspergeris sindromi 299.80 aspergeris aSliloba

F84.8 sxva ganviTarebis perve-siuli aSliloba

F84.9 ganviTarebis gaurkveveli pervesiuli aSliloba

299.80 ganviTarebis gaurkveveli pervesiuli aSliloba

riT xasiaTdeba autizmi?

sindromis saxelwodebidan gamomdinare, autizmis mqone pirs axasiaTebs, pirvel rigSi, garemosTan kontaqtis da-myarebis problema. aseTi bavSvi ar aqcevs yuradRebas

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ojaxis wevrebs, TiTqos verc amCnevs maT, ar TamaSobs sxva bavSvebTan, ver axerxebs sxva adamianisa da situaciis emo-ciuri konteqstis aRqmas, uWirs sakuTari azris, emociis, interesis sxvebisTvis gaziareba. aqvs SezRuduli intere-sebi. ar SeuZlia warmosaxviTi da roluri TamaSi. SeiZleba Segvxvdes autizmis gamovlinebis sxvadasxva xarisxi, magram yvelas, met-naklebad, 3 wlamde ukve umJRavndeba probleme-bi komunikaciaSi, socialur urTierTobaSi, metyvelebaSi, emociur ganviTarebaSi. metad mniSvnelovania, rom ukve CvilobaSi daqveiTebulia e.w. erToblivi yuradReba, rac TvaliT kontaqtsa da sxvebTan gamocdilebis gaziarebas gulisxmobs.

• metyvelebis problemebiautizmis mqone bavSvebi gansxvavdebian metyvelebis gan-

viTarebis doniT. metyvelebis problemebi, SeiZleba, cva-lebadobdes sruli mutizmidan manerul metyvelebamde. yvela SemTxvevaSi, bavSvisaTvis metyveleba komunikaciis sa-Sualebas ar warmoadgens. dialoguri metyvelebisas xSiria eqolaliebi. isini, vinc SedarebiT ukeT metyveleben, ucn-aur metaforebs xmaroben, aqvT formaluri da monotonuri xma, an gawelili, wamRerebiTi intonacia. autizmis mqone bavSvebi, xSirad, Tavis Tavs aRniSnaven mesame da ara pirvel pirSi. aseve, xSiria, sayvarel SezRudul Temebze saubari, neologizmebi, manipulireba bgerebiT, sityvebiT, stereo-tipuli frazebiT.

amrigad, autizmisTvis, ZiriTadad, damaxasiaTebelia eqolalia, autoeqolalia, gadavadebuli eqolalia, ste-reotipuli frazebi, akviatebuli frazebis gameoreba (mag. filmebidan, reklamebidan) da kargi leqsikuri maragis Sem-TxvevaSic ki metyvelebis gamoyenebis SeuZlebloba komuni-kaciis damyarebis mizniT.

metyvelebis ganviTarebis darRvevis simZimisa da xarisx-is mixedviT gamoyofen autizmis mqone bavSvebis sam jgufs (L. Kanner, 1943; o. nikolskaia, �98�):�. am jgufis bavSvebisaTvis miuwvdomelia metyvelebis ko-

munikaciuri funqcia. maT SeuZliaT calkeuli bgerebis, an sityvebis gamoTqma, rac emsaxureba ara komunikacias,

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aramed asaxavs bavSvis afeqtur mdgomareobas an situa-ciaze mis emociuri reagirebas. aReniSnebaT autoeqo-laliebi.

�. am jgufis bavSvebs pirveli sityvebis warmoTqma Seu-ZliaT normaluri ganviTarebisaTvis damaxasiaTebel Cveul periodSi. frazuli metyveleba _ elementaruli frazebis warmoTqma _ 3-4 wlis asakisaTvis yalibdeba, magram SemdgomSi aRar viTardeba. bavSvebis leqsikoni Raribia, frazebi _ stereotipuli; aReniSnebaT rogorc autoeqolaliebi, aseve sityvebisa da frazebis eqo-laliebic;

3. am jgufis bavSvebs sityvis didi maragi da kargad ganvi-Tarebuli frazuli metyveleba aqvT. miuxedavad amisa, maT uWirT komunikaciis dros metyvelebis gamoyeneba. bavSvebis metyveleba stereotipul xasiaTs atarebs, mosaubres rCeba xelovnurobis, meqanikurobis STabeW-dileba.

• komunikaciis darRvevaautizmis mqone bavSvebi xSirad ar reagireben sakuTar

saxelze, eridebian da ar uyureben sxva adamianebs. isini gaurbian pirdapir mzeras, xSirad ewinaaRmdegebian xelSi ayvanas. maT uWirT xmis simaRlis, tembris, an saxis gamome-tyvelebis gansazRvra; ar pasuxoben sxvis emociebs, ver ige-ben sxvisi emociis gamoxatulebas, saxis eqspresias da Jest-ebs, naklebad Sedian kontaqtSi ojaxis wevrebTan, SeimCneva ucnauri gulgriloba axloblebis mimarT. autizmis mqone bavSvebs Cvilobis asakSive aReniSnebaT mijaWvulobis dar-Rveva da emociis gaziarebis problemebi; TiTqos, ar esmiT sxvisi maTdami damokidebuleba da sakuTari moqmedebis gav-lena sxva adamianebze. amis Sedegia TanatolebTan TamaSisa da megobruli urTierTobis damyarebis uunaroba.

sainteresoa, rom jer kidev Cvilobis asakSia SesamCnevi erToblivi yuradRebis daqveiTeba, rac raimeze yuradRebis erTobliv gamaxvilebasa da gamocdilebis reciprokul ga-ziarebas gulisxmobs. mag. Cveulebrivi bavSvi 9 Tvis asak-Si Tvals ayolebs ufrosis mier miTiTebul nacnob sa-gans, xolo � wlis asakSi ki yalibdeba “protoimperatiuli

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miTiTeba”, rodesac bavSvs SeuZlia moipovos sagani ufro-sis yuradRebis mipyrobiT (TvaliT kontaqtiT, JestiT, si-tyviT). am SemTxvevaSi, ufrosi miznis miRwevis saSualebaa. � wlis Semdeg ki yalibdeba “protodeklaraciuli miTiTeba”, rodesac bavSvi ipyrobs ufrosis yuradRebas ara obieqtis mosapoveblad, aramed misTvis saintereso obieqtze da mov-lenaze ufrosis yuradRebis misaqcevad. autisturi speq-tris aSlilobis SemTxvevaSi aseTi erToblivi yuradRebis qcevebi darRveulia.

•sensoruli reaqciis winaaRmdegobrivi niSnebiautizmis mqone bavSvebs sensoruli gamRizianeblebisad-

mi Zlieri hiperesTezia aqvT: mxedvelobiTi, smeniTi, taq-tiluri, gemos Tu sunis stimulebis mimarT mgrZnobeloba Zlier aweulia da usiamovno reaqcias iwvevs. amitom xSirad janmrTeli bavSvebisgan gansxvavebiT, garemo maTTvis usi-amovno SegrZnebebisa da uaryofiTi emociebis momgvrelia. bavSvebisaTvis gansakuTrebulad Zlieri gamRizianebelia adamianis saxe, amitom maT ar SeuZliaT TvalebSi yureba da gaurbian pirdapir mzeras. bavSvi ukve CvilobaSi reagi-rebs uaryofiTad ferad saTamaSoebze, xmebze, tansacmlisa Tu saWmlis garkveul saxeobaze, ar uyvars, roca exebian, ixuteben. aseTi hiperesTezia bavSvebSi SiSebis aRmocenebis fons qmnis.

amave dros, autizmis mqone bavSvebi amJRavneben paradoq-sul ugrZnoblobas garemo gamRizianeblebis mimarT. erTis mxriv, bavSvi SeiZleba SeaSinos sul mcire xmam, meores mx-riv ki Zlier xmaurze, an xmamaRal laparakze ar hqondes reaqcia; iqmneba STabeWdileba, TiTqos dayruebulia. igive SeiZleba iTqvas sxva sensorul modalobebzec. magaliTad, bavSvi arCevs saWmlis faqturas da gemos, ar Wams garkveu-li tipis saWmels, magram SeiZleba pirSi Caidos da SeWamos arasakvebi ram (qaRaldi, foTlebi).

mudmivi sensoruli diskomfortis fonze bavSvebs aReniSnebaT TviTstimulacia (mag. tanis qanaoba, xtunva, triali), romelic kompensatorul xasiaTs atarebs da uc-naur, araadekvatur moqmedebebad aRiqmeba. autisti bavSvi TviTstimulaciiT cdilobs SfoTvis momgvreli da misTvis

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usiamovno garemos mier gamowveuli uaryofiTi emociebis daZlevas da dadebiTad Seferili emociuri mdgomareobis miRwevas.

sensorul gamRizianeblebze aseTi paradoqsuli rea-gireba sensoruli integraciis darRvevis Sedegia. es imas niSnavs, rom bavSvs sxvadasxva sensoruli arxis uCveulod dabali an maRali zRurbli aqvs da amave dros sxvadasxva SegrZnebebiT miRebuli informaciis gaerTianeba srulyo-filad ver xerxdeba. Sesabamisad bavSvs SeiZleba dabali zRurblis gamo hqondes dacviTi reaqcia taqtilur, vesti-bulur, smeniT an mxedvelobiT gamRizianeblebze (gaurbo-des maT), an piriqiT, maRali zRurblis gamo eZebdes Sesaba-misi modalobis gamRizianeblebs da siamovnebdes isini.

• gonebrivi unarebis araTanabari ganviTarebaautizmis mqone bavSvebis umravlesobas gonebrivi Camor-

Cenilobis sxvadasxva xarisxi axasiaTebs, saSualo da saSu-aloze maRali inteleqti mxolod maT �0%-s aqvs. bavSvebs xSirad aqvT xatvis, musikis, angariSis, maTematikis, faqte-bis damaxsovrebis (maTi mniSvnelobis miuxedavad), mxedve-lobiTi garCevis, mxedvelobiT-sivrciTi analizis gaZlie-rebuli unarebi. moumwifebeli da aqselerirebuli unare-bis aseTi kombinacia warmoadgens autizmis gansakuTrebul, paradoqsul Tvisebas.

• cvlilebebisadmi rezistentobaautizmis mqone bavSvebs uWirT raime Secvalon sakuTar

moqmedebaSi da ver itanen garemoSi moulodnel cvlilebebs. axali garemo maTTvis Zlieri uaryofiTi emociebisa da Si-Sebis wyaroa. nacnobi garemosa da yoveldRiuri cxovrebis wesis Tundac mcireodenma cvlilebam (mag. oTaxis mowyoba-Si, Wamis, Tu dabanis procesSi), SeiZleba, bavSvis mkveTrad uaryofiTi reaqcia gamoiwvios. magaliTad, autizmis mqone bavSvebi dadian yovelTvis erTi da imave gziT, erTnairi TanmimdevrobiT icvamen, aqvT stereotipuli ritualebi. Cveul dRis wesrigSi raime cvlileba iwvevs bavSvis, an mo-zardis ukidures gaRizianebas. maT winaswar Semzadeba esa-WiroebaT mosalodnel cvlilebebTan dakavSirebiT.

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• emociuri sferosa da qcevis problemebirogorc aRvniSneT, autisturi qcevis erT-erTi mniS-

vnelovani faqtoria SiSebi, romelTa erT-erTi wyaroc, Sei-Zleba, sensoruli integraciis darRveva iyos. Cveulebrivi sagnebi da movlenebi, SesaZloa, bavSvisaTvis Zlieri SiSis aRmocenebis mizezi gaxdes; aseve, SiSs iwvevs axali situa-cia, axali sagnebi. aseT SiSebTanaa dakavSirebuli ucnauri ritualuri, stereotipuli moqmedebebi, romelTac dacvi-Ti xasiaTi aqvT. autisturi SiSebi amaxinjebs bavSvis mier garemosa da situaciis aRqmas da SeuZlebels xdis bavSvis mier realobis adekvatur gagebas.

autizmisaTvis damaxasiaTebeli stereotipuli moqmede-bebi vlindeba rogorc sxeulis an sxeulis nawilebis gan-meorebad moZraobebSi (mag. taSi, TiTebis grexva, tanis moZ-raobebi, fexis wverebze siaruli, sxeulis ucnauri pozebi), aseve stereotipul qcevebSi, mag. sagnebis zomis mixedviT rigSi dawyoba, erTi sagniT ganmeorebiTi qmedeba da a.S.

bavSvis emociuri da qceviTi darRvevebi kargad Cans TamaSSi. autizmis mqone bavSvebis TamaSi stereotipul xa-siaTs atarebs, maT ar SeuZliaT warmosaxviTi da roluri TamaSi. saTamaSoebze ufro metad bavSvebisaTvis mimzidve-lia sagnebi, sxvadasxva masala da maTi fizikuri efeqte-bi (mag. boTli, Tavsaxuri, Rilebi); isini saTamaSoebidan upiratesobas araspecializebul saTamaSoebs aniWeben (ku-bikebi, mZivebi) xSirad bavSvebs izidavs sagnis romelime nawili an Tviseba (mag. naxvreti, triali, moZraoba, brWyvi-ali, feri, faqtura). spontanuri TamaSi inertul, stereo-tipul xasiaTs atarebs da iSviaTia saTamaSoTi sagnobrivi moqmedebebis ganxorcieleba; xSiria sxvaoba metyvelebaSi gamoxatul moqmedebebsa da saTamaSoebiT realur manipu-lirebas Soris.

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autizmis klinikuri niSnebi

sfero niSnebi

interper-sonaluri garemo

empaTiis uqonloba;socialuri urTierTobis wesebisgagebis daqveiTeba;socialur urTierTobaSi reciprokulobis ararseboba; mijaWvulobis darRveva.

metyveleba metyvelebis ganviTarebis Seferxeba;socialuri saubris darRveva;saubarSi enis SemoqmedebiTi gamoyeneba;eqolalia;neologizmebi;nacvalsaxelebis reversia;

qceva warmosaxviTi TamaSis SeuZlebloba;stereotipuli qcevebi; ritualebi da cvlilebebisadmi Zlieri rezistentoba.

afeqti araadekvaturi emociuri eqspresia;cvlilebaze intensiuri negatiuri emociuri reagireba;SiSebi.

kognituri sfero

75%-s aqvs 70-ze dabali IQ; araverbaluri IQ metia verbalurze;socialuri problemuri situaciis gadawyvetis uunaroba;zogierTi kognituri unaris izolirebuli ganviTareba.

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rogor xdeba autizmis diagnostika?

autizmis diagnostikuri kriteriumebi

DSM-IV-TR

a. qvemoT CamoTvlili niSnebidan minimum 6 mainc unda aRin-iSnebodes:

(�) socialuri urTierTobis Tvisobrivi darRveva, romelic vlindeba Semdegi niSnebidan minimum �-Si mainc:a) mniSvnelovani darRvevebi araverbaluri qcevis

niSnebis gamoyenebaSi (TvalebiT kontaqti, saxis eqspresia, sxeulis poza, Jestebi, romlebic so-cialur urTierTobas axlavs Tan);

b) tolebTan asakis Sesaferisi urTierTobis da-myarebis SeuZlebloba;g) interesebis, sixarulis da sxva emociebis sxva adamianebisaTvis gaziarebis SeuZlebloba, (mag. raimes Cveneba, miTiTeba, motana, mimarTva);

d) socialuri da emociuri reciprokulobis sir-Tule.

(�) komunikaciis Tvisobrivi darRveva, rac vlindeba Sem-degi niSnebidan minimum erTSi:a) metyvelebis ganviTarebis Seferxeba an totalu-

ri CamorCena (Tan ar axlavs JestebiT an mimikiT kompensacia);

b) adekvaturi metyvelebis mqone individebSi dia-loguri saubris dawyebis da SenarCunebis uun-aroba;

g) stereotipuli da ganmeorebadi an idiosinkre-ziuli metyveleba;

d) mocemuli asakobrivi donisaTvis misawvdomi so-cialuri imitaciuri TamaSis, warmosaxviTi Tama-Sis SeuZlebloba.

(3) ganmeorebadi da stereotipuli qcevebis paterne-bi, interesebi da aqtivobebi, rac Semdegidan erTSi mainc vlindeba:

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a) erTi an ramdenime stereotipuli qceviTi pater-nis arseboba, romelic anomaluria Tavisi inten-sivobiT da fokusirebis xarisxiT;

b) ufunqcio ritualebze da wesrigze miwebeba;g) stereotipuli da ganmeorebadi motoruli ma-

nerizmebi;d) obieqtebis nawilebiT intensiuri daintereseba.

b. anomaluri funqcionireba Semdegi sferoebidan erTSi mainc, rac 3 wlamde asakSi vlindeba:• socialur urTierTobaSi;• metyvelebasa da misi socialur komunikaciisaTvis

gamoyenebaSi;• simbolur, warmosaxviT TamaSSi.

g. aSliloba ver miewereba retis sindroms da bavSvobis de-zintegraciul aSlilobas.

ICD-10

pervesiuli ganviTarebis darRveva ganisazRvreba ro-gorc anomaluri ganviTareba, romelic vlindeba 3 wlamde asakSi Semdeg 3 sferoSi: socialuri urTierToba, komunika-cia da ganmeorebadi, stereotipuli qceva. Tvisobrivi darRvevebia reciprokul socialur urTier-TobaSi. es iRebs socialur-emociuri niSnebis araadekvatu-ri Sefasebis formas, rac mJRavndeba sxva adamianebis emo-ciebze reagirebis darRvevaSi da socialuri konteqstidan gamomdinare adekvaturi qcevis ganxorcielebis uunaroba-Si, socialuri signalebis mwir da naklovan gamoyenebaSi; socialuri, emociuri da komunikaciuri qcevebis integra-ciis sisusteSi. komunikaciaSi Tvisobrivi darRvevebi universalur xasi-aTs atarebs. enis socialuri gamoyeneba darRveulia. aseve adgili aqvs: imitaciuri, warmosaxviTi TamaSis darRvevas; metyvelebis eqspresiis simwires da fantaziis deficits azrovnebis procesSi; sxva adamianebis verbalur da araver-balur qmedebebze emociuri reagirebis naklovanebas; in-tonaciis gamoyenebis da sxvisi intonaciis sworad gagebis

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darRvevas; komunikaciis dros Jestebis simwires da maTi gagebis darRvevas. es mdgomareoba xasiaTdeba, agreTve, stereotipuli da ganmeorebadi qcevebiTa da SezRuduli interesebiT. aseve, adgili aqvs dRis wesrigSi da garemoSi moulodneli cvlilebebis miuReblobas.

adreuli bavSvobis periodSi SeiZleba adgili hqonoda mijaWvulobas uCveulo obieqtebze. bavSvi daJinebiT axor-cielebs ufunqcio ritualur, ganmeorebad aqtivobebs. Sei-Zleba adgili hqondes raimis mimarT stereotipul inte-ress. xSirad saxezea motoruli stereotipebi, specifikuri interesi obieqtebis arafunqciuri elementebisadmi (teqs-tura, suni).

atipuri autizmis diagnozi ICD-10-is mixedviT daisme-ba im SemTxvevaSi, roca autizmis damaxasiaTebeli niSnebi SedarebiT ufro gvian vlindeba – 3 wlis Semdeg, an ar akmayofilebs autizmis diagnostikur kriteriumebs Camo-Tvlili 3 sferodan erTSi mainc.

DSM-IV-TR –is mixedviT ganviTarebis gaurkveveli per-vesiuli aSlilobis diagnozis miniWeba xdeba mxolod im Se-mTxvevaSi, Tu mdgomareobis niSnebi ar akmayofilebs yvela diagnostikur kriteriums.

samedicino-laboratoriuli monacemebi:

autisturi speqtris aSliloba xSirad Tan axlavs (ko-morbidulia) genetikur da nevrologiur daavadebebs, mag. rogoricaa tuberozuli sklerozi an myife X sindromi. am SemTxvevaSi misi diagnostikuri kodireba aucilebelia sa-medicino mdgomareobebis ganzomilebazec (ICD-10-is mixed-viT IV ganzomileba: somaturi mdgomareobebi). autizmis mqone pirebs xSirad anomaluri eeg-aqtivoba aReniSnebaT; es klinikurad gulyrebSi autizmis mqone pir-Ta �5%-Si vlindeba. autisturi speqtris aSlilobebis dros SesaZlebelia glutenis da kazeinis cvlis darRvevebi, rac iwvevs rZisa da xorblis produqtebis monelebis problemebs.

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ra iwvevs autizms?

autizmi Tandayolili neirobiologiuri darRvevaa. misi gamomwvevi mizezebi ucnobia. fiqroben, rom mis aRmoceneba-ze gavlenas axdens:

�) neirotransmiterebis funqciis darRveva.

�) genetikuri faqtorebi da memkvidreobiToba.

3) garemos mavne zemoqmedeba.

autizmi, SesaZloa, warmoadgendes ramdenime faqto-ris zemoqmedebis Sedegs. amasTan, bavSvis fsiqo-socialur garemo faqtorebs autizmis mizezad ar Tvlian.

• autizmis mqone adamianebis kvlevebis safuZvelze anoma-liebi da metaboluri darRvevebi gamovlenilia Tavis tvinis Semdeg struqturebSi: naTxemSi, nuSisebr birT-vSi, hipokampSi, gamWvirvale ZgideSi, dvrilisebr sxe-ulebSi, hipoTalamusSi, sartylis xveulSi, Tavis tvinis fronto-orbitalur da Txemis wilis qerqSi (Trevarthen, Aitken, 1998).

• autizmis dros Tavis tvinSi aRmoCenilia serotoninis cvlis darRveva (Trevarthen, Aitken, 1998).

• ukanaskneli periodis gamokvlevebma daadastura, rom arsebobs autizmisadmi genetikuri midrekileba. mec-nierebma daamtkices, rom ojaxebSi, sadac erTi autisti bavSvi hyavT, meore aseTi bavSvis gaCenis riski daaxloe-biT 5%-ia. es maCvenebeli gacilebiT maRalia Cveulebriv, populaciur gavrcelebasTan SedarebiT. monozigoturi tyupebis kvlevebis mixedviT, Tu erT maTgans autizmi aqvs, meoreSi autizmis aRmocenebis albaToba 60%, xolo farTo speqtris komunikaciuri da socialuri defici-ti ki _ 9�% (Bailey et al., 1996). zog SemTxvevaSi autist pirTa mSoblebs, an sxva naTesavebs axasiaTebT iseTi so-cialuri urTierTobebisa da komunikaciis Tavisebure-bebi, romlebic normalur funqcionirebas xels ar uSlis, magram isini, SesaZloa, dakavSirebuli iyos au-tizmTan. dakvirvebam aseve, cxadyo, rom afeqturi dar-

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Rvevebi SedarebiT xSiria autisti adamianebis ojaxebSi, vidre populaciaSi. zogi mkvlevari miuTiTebs autisti bavSvebisa da maTi ojaxebis qromosomul anomaliebze. magaliTad, myife X sindromis mqone bavSvebis �6% ak-mayofilebs autizmis diagnostikur kriteriumebs.

• amJamad gavrcelebulia autizmis poligenuri modeli _ erTdroulad 3 genis deficiti iwvevs autizmis simp-tomebis farTo speqtrs. amJamad aseTi genebis markerebi aRmoCenilia 1p, 7q, 16p, 17p qromosomebze (AAP, 2007).

• marTalia, autizmi ZiriTadad genetikuri etiologiuri faqtorebiTaa ganpirobebuli, garemos faqtorebic mniS-vnelovan rols TamaSobs autizmis fenotipis Camoyalibe-baSi. mag. kongenitalur wiTurasa da autizmis aRmocene-bas Soris kavSiri pirvelad 70-ian wlebSi SeamCnies; aseve kavSiri orsulobis pirveli trimestris dros Talidomi-dis miRebasa da autizmis aRmocenebas Soris (AAP, 2007). aSS da didi britaneTis mkvlevrebi aseve miuTiTeben MMR vaqcinaciis (Cutyvavila-ybayura-wiTura) kavSirze autis-turi speqtris aSlilobis aRmocenebis riskTan, Tumca es mosazrebebi jer ar aris dadasturebuli kontrolire-buli gamokvlevebiT (AAP, 2007).

• autizmis gamomwvevi SesaZlo mavne garemo faqtorebi-dan aRsaniSnavia tyviis, merkuris, kadmiumis, aluminis, vercxliswylisa da sxva qimiuri nivTierebebis zemoq-medeba.

• imunuri sistemis deficitis hipoTeza: imunuri siste-mis daqveiTeba, autoimunuri meqanizmebisa da imunuri regulaciis darRveva maRal korelaciaSia autisturi speqtris aSlilobasTan. autizmis mqone bavSvebSi xSi-ria normaze maRali interferon-alfas done, aweulia eozinofiluri da bazofiluri reaqcia imunoglobulin lgE-ze. zogierTi mkvlevaris azriT paTologiuri auto-imunuri reaqciebi Zlier mowyvlads qmnis centralur nervul sistemas sxvadasxva virusuli zemoqmedebisadmi, rac SeiZleba autizmis erT-erTi faqtori iyos (Hilt et al., 2006).

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autizmis fsiqologiuri etiologiuri Teoriebi mra-valferovania. fsiqogenuri Teoriebis mixedviT, autizmis ZiriTad etiologiur faqtorad fsiqosocialuri faq-torebi iTvleba; biogenuri Teoriebis mixedviT, autizms neirobiologiuri faqtorebi udevs safuZvlad; kognitu-ri Teorebis mixedviT ki autistur darRvevebs safuZvlad udevs specifikuri kognituri meqanizmebi.

fsiqogenuri Teoriebi autizmisaTvis damaxasiaTebeli socialuri, komunikaciuri da qceviTi niSnebis etiolo-giur faqtorad mSoblebis araadekvaturi damokidebule-biT gamowveul emociur sirTuleebs miiCneven. Bethelheim (�967) Tvlida, rom autisturi Caketiloba aris mSoblebis civ, uemocio, araadekvatur damokidebulebaze bavSvis reaqcia. autizmis iseTi niSnebi, rogoricaa eqolalia, ste-reotipuli ritualebi da cvlilebebisadmi rezistentoba, mSoblebis mimarT mtruli damokidebulebis gamovlinebaa, radganac isini bavSvs ver ukmayofileben moTxovnilebebs.

am midgomis farglebSi mkurnalobis strategia xan-grZlivi fsiqodinamikuri fsiqoTerapiaa. Terapiis mizania bavSvi-mSoblis urTierTobis ganviTareba, raTa dakmayo-fildes bavSvis siTbosa da misi miRebis moTxovnilebebi. aseve, rekomendebulia mSoblebis emociuri problemebis daZleva fsiqoTerapiuli meTodiT.

kognituri Teoriebi. autizmis simptomebis gamomwvevi disfunqciebis speqtris mixedviT Carr (�999) gamoyofs kog-nituri Teoriebis oTx viwro da or farTo Teorias.

`viwro Teoriebis~ mixedviT autizmis centraluri de-ficitia:

• socialuri kogniciis darRveva (Hermelin, O’connor, 1970; Sigman, 1995);

• emociis aRqmisa da gagebis deficiti (Hobson, 1993);

• `gonebis Teoriis~ deficiti, rac niSnavs, rom ver xerx-deba sxvisi Sinagani, fsiqikuri mdgomareobis kognituri reprezentacia (Baron-Cohen, 1995);

• epizoduri, avtobiografiuli mexsierebis deficiti, rac gamowveulia me-sTan dakavSirebuli movlenebis,

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faqtebis mniSvnelobis Sefasebis defeqtebiT. vinaidan autisti bavSvebi saTanadod ver ganicdian im movlenebs, rac maT Tavs xdeba, amitom maTi gaxsenebac uWirT (Jor-dan, Powell �995).

`viwro~ Teoriebis sapirispirod Carr � `farTo~ Teo-rias gamoyofs:

• Frith, Happe (�994) Tvlian, rom autizmis ZiriTadi pro-blemaa pirovnebis mier situaciis konteqstis gagebis deficiti; autizmis mqone adamiani ver xvdeba situaciis globalur niSnebs da informacias ufro metad nawil-nawil amuSavebs da ara mTlian konteqstSi.

• Ozonoff-is (�994) mixedviT autizmis dros xSiria `aRmas-rulebeli~ funqciebis deficiti, rogoricaa: moqmede-bis dagegmva, impulsuri reaqciebis kontroli, kogni-turi ganwyobis SenarCuneba, kontroli, moqmedebis mo-nitoringi da ukukavSiri misi koreqciis mizniT; kogni-turi ganwyobis gadarTvis moqniloba.

autizmis SemTxvevaSi ganviTarebis deficitis arsebobis asaxsnelad, SeiZleba, ganvixiloT sami ZiriTadi Teoriuli modeli:

• metareprezentaciuli deficitis hipoTeza (Baron-Co-hen, Leslie, Frith, 1985);

• afeqtis Teoria (Hobson, 1988,1991);

• intersubieqturobis modeli (Rogers, Pennington, 1991; Sigman, 1989; Trevarthen, 1979).

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autizmis pirveladi deficitis Teoriuli modelebi(Rogers, Pennington, 1991)-is mixedviT.

hobsonis afeqtis Teoria (Hobson, 1989, 1991)

metareprezentaciuli Teoria (Frith, Lesley, Baron-Coheb, 1985)

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intersubieqturobis Teoria (Rogers, Pennington, 1991)

metareprezentaciuli modeli kognituri modelia, romelic e.w. `gonebis Teoriis~ (Theory of mind) sxvadasxva sazomebs efuZneba. metareprezentacia gulisxmobs pirve-ladi, obieqtebisagan zusti reprezentaciebis gamoyofas ise, rom am reprezentaciebis gamoyeneba SesaZlebeli gaxdes warmosaxviT. bavSvis mier sxvisi qcevis winaswarmetyvelebi-sa da axsnis unaris ganviTareba gulisxmobs sxva adamianebis fsiqikuri mdgomareobis, maTi ganzraxvis, miswrafebebisa Tu Sexedulebebis gagebas. sxvebis intenciis gagebis unars bavSvi dabadebidan ar amJRavnebs. erTi wlis asakSi bavSvebs SeuZliaT aRiqvan fizikuri samyaro da gaixsenon is, rac aRiqves. es pirveli rigis reprezentaciaa. ori wlidan ki iwyeba meore rigis reprezentaciis unaris ganviTareba, rac bavSvs aZlevs rogorc fizikuri, ise fsiqikuri mdgomareo-bis warmodgenis saSualebas. bavSvi ara marto aRiqvams sxve-bis qcevas, rogorc ubralod damkvirvebeli, aramed Seu-Zlia am qcevidan garkveuli azrisa da daskvnis gamotana an sxva adamianis Sinagani mdgomareobis gansazRvra. oTxi wlis asakisaTvis bavSvs SeTvisebuli aqvs, rom adamianebs gansxvavebuli warmodgenebi aqvT, maT Soris, mcdaric. ase-Ti tipis situaciebi da davalebebi autisti bavSvebis 80%-isaTvis miuwvdomelia, maSin, roca gonebrivad CamorCenili

�86

da janmrTeli bavSvebi Tavisuflad axerxeben sxvisi qcevis anticipaciasa da emociuri mdgomareobis gagebas. meta-reprezentaciul davalebebSi autisti bavSvebi ver axerxe-ben sxvisi e.w. `gonebis Teoriis~ Camoyalibebas, anu sxva adamianis fsiqikuri mdgomareobis _ misi fiqrebis, warmod-genebis, ganzraxvis gagebas da gaTvaliswinebas (Baron-Co-hen, Leslie, Frith, 1985; Frith, Hoppe, 1994).

metareprezentaciuli Teoriis mixedviT, autist bavS-vs SeuZlia pirveladi reprezentaciis Camoyalibeba mis garSemo arsebuli obieqtebisa da sxva pirovnebis, an sa-kuTari me-s Sesaxeb, magram igi veRar gadadis sxva doneze, rodesac ukve sxvisi fsiqikuri mdgomareobis reprezent-aciaa saWiro. es modeli gamoiyeneba autizmis dros sim-boluri TamaSis deficitisa da komunikaciis pragmatuli aspeqtis darRvevis asaxsnelad.

aRniSnuli modelis oponentebi aRniSnaven, rom metareprezentaciuli modeliT SeuZlebelia imitaciis deficitis axsna, radgan es unari bavSvebs erToblivi yu-radRebisa da simboluri TamaSis unarze ufro adre uvi-TardebaT. amasTan, simbolizaciis unarsa, erTobliv yur-adRebasa da metareprezentaciis Camoyalibebas Soris urT-ierTkavSiri ar aris dadgenili. amis garda, zemoaRniSnu-li modeli verc afeqturi sferos darRvevis asaxsnelad gamodgeba (Rogers, Pennington, 1991), radgan e.w. `gonebis TeoriiT~ SesaZlebelia autizmis mxolod zogierTi simp-tomis da ara yvela maTganis axsna.

afeqtis deficitis Teoriis mixedviT autizmis dros gamovlenili darRvevebi _ simbolur TamaSSi, komunika-ciaSi, Semecnebasa da metyvelebaSi, afeqturi ganviTarebis pirveladi, kerZod, emociuri reaqtiulobis problemidan gamomdinareobs (Kanner, 1943; Hobson, 1989). es deficiti moicavs emociuri eqspresiisa da misi aRqmis darRvevas, sxva adamianebTan reciprokuli emociuri urTierTobis Camoya-libebis SeuZleblobas. am deficitis gamo autist bavSvs ar SeuZlia intersubieqturi warmodgenis Seqmna sakuTar Tav-sa da sxvebze. darRveulia afeqtis aRqma da gageba (Hertzig et al., 1989; McDonald et al., 1989; Hobson, 1993). autist bavS-vebTan emociis gaziarebasa da mis gamoxatvaSi specifikuri

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deficiti vlindeba daqveiTebuli dadebiTi emociebis, gaz-rdili negatiuri afeqtis, emociuri eqspresiis cnobis sir-Tulis, socialuri partnioris mimarT daqveiTebuli afeq-turi reaqciis saxiT, rac arTulebs, an SeuZlebels xdis aseTi adamianebis sxvebTan urTierTobas (Sigman, 1975; Hob-son, 1993). sagulisxmoa, rom autizmis dros emociis aRqma, zogadad, darRveuli ar aris.

intersubieqturobis modeli. intersubieqturoba niS-navs adamianis mier Sinagani, subieqturi, kognituri Tu emociuri gamocdilebis gaziarebas sxva adamianebisaTvis. am modelis mixedviT autizmis ZiriTadi defeqti mdgo-mareobs sakuTari me-sa da sxvebis Sesaxeb warmodgenebiT manipulirebis unaris darRvevaSi. es reprezentaciebi bavS-vis imitaciis, afeqtis arekvlis da gaziarebis unarisa da sxvebis subieqturi mdgomareobis gagebis unaris safuZve-lia. normaluri ganviTarebisas `gonebis Teoria~, imita-ciisa da emociis gaziarebis unari mimdevrobiT viTardeba. amitom, autizmis dros, erTi romelime maTganis deficiti sxvebis ganviTarebaze axdens gavlenas (Rogers, Pennington, 1991). es samive unari metad mniSvnelovania erToblivi yu-radRebis, metyvelebis pragmatuli mxaris da warmosaxviTi TamaSis ganviTarebaSi. autizmis dros darRveulia inter-subieqturi TviToba, rac iwvevs interpersonaluri urT-ierTobisa da emociis gaziarebis unaris darRvevas (Stern, 1985; Sigman, 1989). intersubiqturi TviTobis Camoyali-bebis darRvevis safuZveli, SeiZleba, informaciis erTi sensoruli modalobidan sxva modalobaSi gadatanis unaris Tandayolili darRveva iyos (Stern, 1985). aseTi gadatana SesaZlebelia mxolod amodaluri reprezentaciis saSu-alebiT, romelSic yvela modalobaa warmodgenili. Stern-is mixedviT, autizmis mqone pirebSi TviTobis safuZveli swored amodaluri informaciis gadamuSavebis sirTulea da ara misi naklovaneba.

zemoaRniSnuli modelebis saSualebiT mkvlevrebi cdi-loben im ZiriTadi meqanizmisa da pirveladi defeqtebis axsnas, rac autizmis dros safuZvlad udevs sxvadasxva fsiqikuri funqciis darRvevas. Tumca, unda aRiniSnos, rom autizmis mravalferovani simptomatikis axsna mxolod

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kognituri deficitiTa da meta-reprezentaciis darRveviT ver xerxdeba, radgan yoveli modeli gamosadegia autiz-mis gamovlinebis mxolod erTi an ramdenime mxaris asaxs-nelad.

ramdenad xSiria autizmi?

autizmi gvxvdeba msoflio mosaxleobis yvela rasisa da socialuri mdgomareobis pirTa Soris; epidemiologiuri monacemebiT yovel �0000 adamianze 5 SemTxveva modis. Tum-ca, imis mixedviT, Tu rogori sadiagnostiko kriteriumebiT xelmZRvaneloben specialistebi, SemTxvevaTa prevalensi �-dan �0 SemTxvevamde meryeobs �0000 mosaxleze. amasTan, au-tizmi 4-5-jer ufro xSiria mamakacebSi, vidre qalebSi.

ra ZiriTadi problemebi gvxvdeba autizmis dros?

zogierTi mkvlevari autisti bavSvebis daxasiaTebisas iyenebs termins `emociuri wonasworobis darRveva~. autiz-mi gansxvavebulia simZimisa da simptomebis mixedviT, amitom am mdgomareobis ZiriTadi problemebis gansazRvras didi mniSvneloba eniWeba. autizmis mqone bavSvebs gansakuTrebiT uWirT socialuri qceva, adamianebTan urTierToba, me-tyvelebis daufleba.

autizmis SemTxvevaSi Semdeg ZiriTad problemebs vx-vdebiT:

• metyvelebis gamoyenebis, an gagebis darRveva: metyvele-ba xasiaTdeba perseveraciebiT, eqolaliebiT, stereo-tipulobiTa da uCveulobiT;

• metyvelebis gamoyeneba komunikaciis mizniT ver xerx-deba;

• mSoblebTan, momvlelebTan da maswavleblebTan urT-ierTobis damyarebis unaris daqveiTeba, an SeuZle-bloba;

• TanatolebTan urTierTobis damyarebis uunaroba;

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• sxvisTvis azris da emociis gaziarebis SeuZlebloba;

• erToblivi, ziari yuradRebis daqveiTeba, an SeuZle-bloba;

• warmosaxviTi, roluri TamaSis unaris daqveiTeba, an SeuZlebloba;

• saTamaSoebiT, ufro metad ki sagnebiT, aratradiciuli TamaSi;

• interesebis Zlieri SezRuduloba;

• situaciis, yoveldRiuri ganrigisa da aqtivobebis cvli-lebisadmi Zlieri rezistentoba;

• sagnebis detalebze yuradRebis gamaxvileba; gvirabise-buri xedva: bavSvi reagirebs sagnis mravali maxasiaTeb-lidan mxolod erT romelime maTganze;

• gonebrivi unarebis araTanabari ganviTareba;.

• CamorCena gonebriv ganviTarebaSi;

• stereotipuli qcevebi da sxeulis moZraobebi;

• TviTdamazianebeli da agresiuli qceva;

• TviT-stimulacia.

• SiSebi da maRali SfoTva.

problemebis identifikaciasTan erTad metad mniSvne-lovania autizmis mqone bavSvis Zlieri mxareebis Sefaseba. bavSvebs SesaZlebelia qvemoT CamoTvlili SesaZleblobe-bidan erTi an ramdenime kargad ganviTarebuli unari hqon-deT:

• araverbaluri inteleqti;

• xatva;

• perceptul-motoruli unarebi;

• gamorCeuli mxedvelobiTi mexsiereba;

• mxedvelobiT-sivrciTi unarebi;

• musikaluri unari;

• kompiuterisadmi interesi da misi gamoyenebis advilad aTviseba.

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SeiZleba Tu ara davexmaroT autizmis mqone bavSvs da rogor?

autizmis mqone bavSvis daxmareba, pirvel rigSi, misi swori da drouli diagnostikaa.

kvlevebi adastureben, rom autisturi speqtris aSli-lobis SemTxvevaSi mSoblebis pirveli Civili bavSvis ganvi-TarebasTan dakavSirebiT �8 Tvis asakSi aRiniSneba. rogorc wesi, ZiriTadi Civilia metyvelebis ganviTareba – bavSvi ar laparakobs da arc ufrosebis laparaks aqcevs yuradRe-bas. amis Semdeg saSualod mxolod 6 TveSi mimarTaven mSo-blebi profesiul daxmarebas. bunebrivia, rom bavSvs afa-sebs an pediatri an bavSvTa nevrologi. mimarTvebis 50%-Si eqimi Tvlis, rom sagangaSo araferia da saWiroa mxolod moTminebiT lodini. Sesabamisad, SemTxvevaTa umravlesoba-Si formaluri diagnozi ukve 5-6 wlis asakSi ismeba. es ki mniSvnelovnad aferxebs adreuli intervenciisa da drouli daxmarebis SesaZleblobas.

situacias arTulebs is garemoebac, rom diagnostikuri kriteriumebis gamoyeneba 3 wlidan aris SesaZlebeli da ma-namde zusti diagnostika SeuZlebelia. klinikuri praqtika da gamocdileba gviCvenebs, rom diagnostikuri efeqturo-bis gazrdisaTvis mniSvnelovania:

mSoblebis Civilebis seriozuli Sefaseba;

bavSvis ganviTarebis detaluri monitoringi, ara mxo-lod motorikisa da SemecnebiTi unarebis, aramed emo-ciuri da socialuri sferosic;

pediatrisa da bavSvTa nevrologis mier bavSvis ganviTa-rebis Sefasebisas pervesiuli aSlilobis sadiagnostiko skriningis aucilebloba;

eWvis SemTxvevaSi, samuSao diagnozis miReba da bavSvis xelmeore Sefaseba 3 Tvis Semdeg. eWvis dadasturebis SemTxvevaSi bavSvis specializebul gamokvlevaze mimar-Tva da sxva specialistebis CarTva.

idealur SemTxvevaSi bavSvis Sefaseba unda moxdes mul-tidisciplinuri gundis mier, romelSic gaerTianebulni

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arian pediatri an nevrologi, neirofsiqologi, metyvele-bis Terapevti, bavSvTa fsiqiatri, okupaciuri Terapevti. bavSvis Sefaseba xdeba mSoblebisa da maswavlebelebis in-terviurebis, bavSvis qcevaze dakvirvebisa da fsiqometru-li testebis monacemebis safuZvelze.

metad mniSvnelovania gakeTdes diferencialuri diag-nozi sxva mdgomareobebis gamosaricxad, rogoricaa:

• smenis gamoxatuli daqveiTeba; ICD-10, F70

• gonebrivi CamorCeniloba; ICD-10, F70

• receptuli metyvelebis ganviTarebis specifikuri dar-Rveva; ICD-10, F80.2

• landau-klefneris sindromi; ICD-10, F80.3

• eleqtiuri mutizmi; ICD-10, F94.0

• mijaWvulobis reaqtiuli darRveva; ICD-10, F94.1

• bavSvTa Sizofrenia; ICD-10, F20

• deprivacia

• sensoruli integraciis darRveva.

smenis darRvevis Sefaseba audiologiuri gamokvle-viT xdeba. smenadaqveiTebuli bavSvebi kontaqts TvalebiT amyareben da reciprokul socialur urTierTobaSi Jest-ebis enis saSualebiT erTvebian. inteleqtis darRvevis mqone bavSvebs ara aqvT reciprokuli socialuri urTierTobis deficiti da maTi metyvelebis ganviTareba Seesabameba in-teleqtis ganviTarebis dones. metyvelebis specifikuri ganviTarebis darRvevis dros bavSvebs ara aqvT araverbal-uri komunikaciis siZnele da stereotipuli moqmedebebi. eleqtiuri mutizmis dros bavSvi ar metyvelebs konkret-ul situaciaSi, ZiriTadad, skolaSi, maSin, rodesac axlo-blebTan Cveulebrivad urTierTobs.

autizms Zlier hgavs fsiqosocialuri deprivaciis md-gomareoba. am drosac saxezea uCveulo interpersonaluri qceva da stereotipuli qcevis paternebi. bavSvis qceva normalizdeba socialuri garemos mowesrigebasTan erTad.

bavSvTa Sizofreniis dros, daavadebis dawyebamde, bavS-

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vebs normaluri ganviTarebis istoria aqvT. maT ar aReniS-nebaTY autizmisaTvis damaxasiaTebeli metyvelebis gagebis sirTule.

sensoruli integraciis darRveva gulisxmobs sensoruli arxebis mier informaciis miRebis zRurblebis paTologiur Secvlas ise, rom irRveva garemosTan adaptacia. kerZod, es SeiZleba iyos smeniTi, mxedvelobiTi, vestibuluri, pro-prioceptuli, taqtiluri arxebis hipo- da hiperfunqcia. amis Sedegad bavSvi ver axerxebs am arxebiT miRebuli infor-maciis avtomaturad integrirebas. aman SeiZleba gamoiwvios hiperaqtivoba, impulsuroba, siaxlisadmi da cvlilebebi-sadmi rezistentoba, SiSebi da stereotipuli moqmedebebi.

autizmis pirveladi diagnostirebisaTvis samedicino sferoSi gamoiyeneba autizmis Sesafasebeli skriningis kiTxvarebi, romelsac advilad gamoiyenebs ojaxis eqimi, pediatri an bavSvTa nevrologi. eWvis SemTxvevaSi mSoblis interviureba xdeba ukve specializebuli skalebis gamoy-enebiT pervesiuli aSlilobis SefasebaSi gawvrTnili spe-cialistis mier. gavrcelebuli skalebia: bavSvobis autiz-mis Sesafasebeli skala (SCARS), romelic gamoiyeneba � wl-idan, autizmis qceviTi kiTxvari (ABC), giliamis autizmis Sesafasebeli skala (GARS), romelic gamoiyeneba 3 wlidan, autizmis diagnostikuri interviu (ADOS), romelic ufro kvleviTi da ara klinikuri miznebisTvis gamoiyeneba.

autizmis mqone bavSvis daxmareba da misi simptomebis mniSvnelovani Semsubuqeba SesaZlebelia swori midgomisa da mkurnalobis SemTxvevaSi. autizmi qronikuli mdgomareo-baa da misi gankurnebis samedicino saSualeba ar arsebobs. amave dros, mraval qveyanaSi Catarebuli kvlevebis mixed-viT autizmis mqone bavSvis mdgomareobis Semsubuqeba da mniSnvelovnad gaumjobeseba SesaZlebelia adreuli inter-venciis programebis gamoyenebis SemTxvevaSi. kvlevebi adas-tureben, rom rac ufro adre xdeba Careva da sistematuri daxmareba bavSvisa da misi ojaxis wevrebisaTvis, miT ufro ukeTesia bavSvis ganviTarebis prognozi (Szatmari, 1995; AAP, 2007).

adreuli intervenciis programebi mimarTulia autiz-mis ZiriTadi niSnebis Semsubuqebaze, pirvel rigSi komu-

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nikaciis, metyvelebis da socialuri interaqciis unare-bze. autizmis dasaxmarebeli programebis analizma cxadyo, rom saukeTeso da efeqturia programebi, romlebic rac SeiZleba adreul asakSi iwyeba, sadac gamoiyeneba bavSvisa da ojaxis individualizebuli momsaxureba, struqturire-buli da sistematuri swavleba da ojaxis wevrebis aqtiuri CarTuloba (Dawson, Osterling, 1997; Smith, Lovaas, 1998; AAP, 2007).autizmis dasaxmareblad gavrcelebuli programebi moicavs Semdeg komponentebs:

• fsiqoganaTleba, romlis meSveobiTac mSoblebi infor-macias Rebuloben Svilis diagnozis, misi prognozis, mi-sawvdomi da saWiro daxmarebis Sesaxeb;

• bavSvis Sesaferis saswavlo garemoSi mosaTavseblad rCevebis micema da mxardaWera;

• ojaxze fokusirebuli xangrZlivi Terapiuli midgoma;

• saswavlo aqtivobis centraluri meTodi _ struqturi-rebuli swavleba;

• qceviTi modifikacia _ saswavlo Cvevebis Camoyalibebisa da mZime qceviTi darRvevebis Sesamcireblad;

• TviTmomsaxurebisa da akademiuri Cvevebis treningi;

• komunikaciuri unarebis treningi;

• mZime, TviTdamazianebeli qcevis regulireba.

adreuli intervenciis programebidan yvelaze gavrcele-bulia ivar lovaasis meTodi (Lovaas, 1987). misi programa saSualod �.6 wlis asakSi iwyeba da moicavs erTi-erTze swavlebas kviraSi 40 saaTi, � wlis ganmavlobaSi. treningis meTodis ZiriTadi samiznea: imitaciuri aqtivoba da TamaSi, metyvelebis ganviTareba, komunikacia da tolebTan urT-ierToba. � wlis Semdeg bavSvebis 50% mniSvnelovnad gaum-jobesda da miuaxlovda asakobriv normas; 5 wlis Semdegac es gaumjobeseba myari iyo (AAP, 2007).

aSS-Si gavrcelebuli meore efeqturi adreuli inter-venciis programaa grinsfenis da uaidenis urTierTobaze

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damyarebuli midgoma. mas safuZvlad udevs varaudi, rom autizmis simptomebi gamowveulia sensoruli modulaciisa da gadamuSavebis problemebiT, motoruli dagegmvisa da afeqturi integraciis darRveviT; amave dros, bavSvis gan-viTarebisaTvis metad mniSvnelovania misi ojaxis wevrebTan aqtiuri urTierToba. am programis farglebSi specilisti da mSobeli erToblivad muSaoben komunikaciis stimulaci-aze da amisaTvis iyeneben sxvadasxva TamaSebs (AAP, 2007).

kvlevebma cxadyo, rom autisti bavSvebis garkveul ra-odenobas komunikaciuri funqciis gaumjobeseba special-uri komunikaciuri Cvevebis treningis programebis gamoy-enebis Sedegad aReniSneba.

komunikaciuri treningis pirveli nabijia bavSvis me-tyvelebis funqciebis Sefaseba. bavSvisaTvis misawvdomi sametyvelo donis bazaze xdeba komunikaciuri treningis programis SemuSaveba. treningi tardeba yovveldRiurad 30 wuTis ganmavlobaSi. Tu bavSvi ver iyenebs sakuTar me-tyvelebas socialur konteqstSi, saWiroa naturaluri situaciebis modelireba da bavSvis waxaliseba. aqcenti unda gakeTdes ara metyvelebaze, aramed komunikaciaze. treningi mimarTuli unda iyos intonaciisa da Jestebis adekvatur gagebasa da gamoyenebaze, eqolaliebis, nacvalsaxelis re-versiis koregirebaze. xandaxan iyeneben video-modelire-basa da video-treningsac, romelic mimarTulia socialuri signalebisa da socialuri wesebis gagebaze.

autizmis SemTxvevaSi Terapia an daxmareba mimarTulia calkeuli individis specifikuri simptomebis Semsubuqe-baze. am TvalsazrisiT erT-erTi efeqturi gzaa qceviTi modifikacia. igi warmoadgens gegmazomieri da intensiuri swavlebis meTods, romelic calkeuli bavSvisaTvis indi-vidualurad SemuSavdeba da ZiriTadad mimarTulia qcevis marTvaze, misaRebi komunikaciuri qcevis ganmtkicebaze da socialuri interaqciebis gaumjobesebaze. swavlebis pro-cesSi Terapevtebi cdiloben dadebiTad ganamtkicon komu-nikaciuri aqtivobebi, misaRebi qceva da Seamciron araadek-vaturi, umarTavi qcevis aRmocenebis albaToba.

mSoblebis ganaTleba da treningi erT-erTi yvelaze mniS-venlovani strategiaa autizmis mkurnalobisas. mSoblebis

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treningi uzrunvelyofs Terapiul daxmarebasTan erTad bavSvis qcevis gagebasa da marTvas mSoblebis mier, mSoblebis SfoTvis Semcirebas, bavSvis swavlebisaTvis saWiro pirobebis Seqmnas ojaxSi, bavSvis saWiroebebidan gamomdinare saxlis garemos mowyobasa da organizebas. kvlevebma cxadyo, rom im bavSvebs, romelTa mSoblebsac utardebodaT intensiuri treningi da saganmanaTleblo saubrebi, bevrad ufro uke-Tesi Terapiuli da swavlebis Sedegebi hqondaT (AAP, 2007).

metad efeqturia okupaciuri Terapia, rac SeiZleba ad-reuli asakidan, radgan autist bavSvebs darRveuli aqvT sensoruli integracia.

ar arsebobs autizmis mkurnalobis specifikuri farmak-ologiuri meTodi. medikamentozur mkurnalobas simptoma-turi xasiaTi aqvs da iniSneba TviTdamazianebeli qcevis, SfoTvis da SiSebis, epilefsiuri Setevebisa da yuradRebis darRvevis simptomebis Sesamcireblad. ZiriTadad iyeneben neiroleptikebs (mag. risperidons), stimulantebs da sero-toninis seleqciur inhibitorebs.

specialuri kvebiTi dietis (rZis, gluteinisa da kazein-is kvebis racionidan amoReba), imunoglobuliniT Terapiis, sekretiniT Terapiis Sedegebis Sesaxeb ar aris kontroli-rebuli gamokvlevebi da sakmarisi faqtebi am midgomebis efeqturobis utyuarobis dasamtkiceblad (AAP, 2007).

rogor vaswavloT autizmis mqone bavSvs?

autisti bavSvis Terapiul daxmarebaSi ZiriTad prob-lemas is warmoadgens, Tu sad unda iswavlos aseTma bavSvma _ specialur skolaSi Tu zogadsaganamanaTleblo klasSi? am kiTxvaze arc saboloo da kategoriuli pasuxi arsebobs da arc SedarebiTi analizis faqtebi moipoveba romelime midgomis sasargeblod. eTikurad yvela eTanxmeba farTod gavrcelebul azrs imis Sesaxeb, rom autist bavSvs unda hqondes normaluri cxovrebis SesaZlebloba da amitom specifikuri damatebiTi daxmarebiT unda swavlobdes zoga-dsaganmanaTleblo skolaSi; magram, pragmatulad, praqtiki-dan gamomdinare xSirad, rTulia zogadsaganmanaTleblo

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skolis pirobebSi autisti bavSvebisaTvis Sesaferisi gare-mosa da pirobebis Seqmna, ise rom man adekvaturi ganaTleba an daxmareba miiRos.

autizmis mqone bavSvebisaTvis didi mniSvneloba aqvs swavlebis adekvaturad SerCeul programebs, Zlier struq-turirebul, winaswarmetyvelebad da kargad organizebul saswavlo garemos. swavlebis programebSi gaTvaliswinebu-li unda iyos urTierTobis, socialuri daswavlis, qcevi-sa da yoveldRiuri cxovrebis Cvevebis gasaumjobesebeli meTodebi. qcevis an urTierTobis problemebi, romlebic xels uSlis bavSvs swavlis procesSi, moiTxovs kvalifici-uri profesionalis daxmarebas da mis mier skolasa da saxlSi gansaxorcielebeli specialuri gegmis SemuSavebas. bavSvi unda swavlobdes mis Zlier da sust mxareebze morge-buli individualuri saswavlo gegmiT da individualize-buli saswavlo programiT. saklaso oTaxi ise unda moewyos, rom xels uwyobdes programis realizebas. rodesac autiz-mis mqone moswavleebs informacia miewodebaT rogorc si-tyvierad, ise vizualurad, isini masalas ukeT iTviseben da naklebad ibnevian. aseve, mniSvnelovania Cveulebrivi ganvi-Tarebis mqone TanatolebTan urTierToba, radgan janmrTe-li bavSvebi iZlevian saubris, socialuri da qcevis Cvevebis magaliTebs. udidesi mniSvneloba aqvs mSoblebisaTvis pro-gramebis SemuSavebas, raTa aseTi bavSvebis swavlebis meTo-debi, gamocdileba da midgomebi ojaxsa Tu sazogadoebaSic gavrceldes.

autisti bavSvis swavlebis efeqturobisTvis mniS-vnelovania misi `swavlis stilis~ dadgena. `swavlis stili~ gulisxmobs im meTodebsa da xerxebs, romelTa saSualebiT-ac adamianebs SeuZliaT garemos Sesaxeb informaciis miRe-ba. adamianebma, SeiZleba, iswavlon danaxviT (vizualurad), mosmeniT (auditorulad) da/an SexebiT an sagnebis manipu-lirebiT (kinesTetikurad, `xelebiT swavla~).

autisti bavSvebi, xSirad, swavlis erT romelime stils iyeneben. adamianze dakvirvebiT, SesaZlebelia, misi swavlis ZiriTadi stilis gansazRvra. mag. Tu autisti bavSvi aT-valierebs suraTebian wigns, uyurebs televizors (aweuli xmiT an xmadabla), akvirdeba xalxs da sagnebs _ misi swavlis

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stili vizualuria. Tu autisti bavSvi bevrs laparakobs, moswons, roca mas elaparakebian, usmens radios an musikas _ misi swavlis stili auditorulia. xolo, Tu autisti bavSvi sagnebs gamudmebiT Slis nawilebad, aRebs da xuravs ujrebs da cdilobs, yvelaferi xeliT mosinjos, es niSnavs, rom aseTi bavSvi kinesTetikurad, anu SexebiT swavlobs.

bavSvis swavlis stilis garkveva zrdis bavSvis swavlis SesaZleblobis albaTobas. Tu maswavlebelma zustad ar icis swavlis romeli stilia damaxasiaTebeli bavSvisTvis, an muSaoba uxdeba swavlis sxvadasxva stilis mqone bavSvebis jgufTan, saukeTeso meTodia swavlis samive stilis gamoy-eneba. mag. sityva `vaSlis~ swavlebisas aCvenebs naturalur vaSls (vizualuri), aRwers mis Tvisebebs: feri, Semadgenlo-ba, gamoyeneba (smeniTi), Semdeg bavSvs aZlevs vaSls xelSi (kinesTetikuri) da asinjebs mis gemos (gemovnebis _ gusta-toruli).

mniSvnelovania bavSvis unari _ miiRos da gadaamuS-aos miwodebuli informacia. amazea damokidebuli bavS-vis warmateba da qceva skolaSi. amitom aucilebelia, rom skolaSi bavSvis misvlisTanave maswavlebelma gaarkvios da Seufardos mas misTvis saWiro swavlis stili. aseT SemTx-vevaSi autisti bavSvi maqsimalur warmatebas miaRwevs.

autizmis mqone bavSvebis efeqturi ganaTlebisaTvis aucilebeli da mniSvnelovania, rom ojaxma aqtiuri monaw-ileoba miiRos struqturirebuli swavlebisa da intensi-uri qcevis treningis programebSi (mag. Lovaas-is programa, �993).

Schopler-ma da misma jgufma SeimuSava struqturirebuli swavlebis sistema TEACHH (�997). am programis mizania, au-tizmis mqone bavSvis problemebis gaTvaliswinebiTa da mis Zlier mxareebze dayrdnobiT, SemuSavdes struqturirebu-li saswavlo aqtivobebi. am sistemaSi saswavlo aqtivobebi isea mowodebuli, rom bavSvs SeeZlos miznis vizualizeba, moqmedebebi TanmimdevrobiT iyos damaxsovrebuli da aRd-genili, davalebebis Sinaarsi ki gamomdinareobdes bavSvis specifikuri interesebidan. am sistemaSi erTdroulad ori klinicisti muSaobs: erTi _ bavSvis Terapevtia, meore ki mSoblis konsultanti. Terapevti muSaobs uSualod bavS-

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vTan da adgens saxlSi gansaxorciebel yovelkvireul pro-gramas. mSoblis konsultanti muSaobs mSoblebTan, gegmavs bavSvis swavlebisa da misi qcevis regulaciis strategiebs, aswavlis mSoblebs, rogor unda moaxerxon bavSvis anomal-uri qcevis marTva. mSobelma, yoveldRe, �0 wuTis ganma-vlobaSi unda ganaxorcielos Terapevtis mier Sedgenili programa. tipuri programa oTxi-xuTi aqtivobisagan Sedge-ba, romelic bavSvis mdgomareobis Sesabamisi sirTulisaa. mSoblebs aswavlian, Tu rogor unda moawyon bavSvis sa-muSao da saTamaSo garemo, acnoben da praqtikulad aCvene-ben aqtivobebs, aZleven instruqciebs da aswavlian xerxebs bavSvis mier sasurveli moqmedebis Sesrulebis misaRwevad.

sxva meTods warmoadgens iaponiaSi higaSis skolis mid-goma, romlis analogi masaCusetis StatSic gakeTda. es midgoma yuradRebas amaxvilebs xelovnebiT swavlebasa da fizikur aRzrdaze waxalisebisa da stimulirebis gziT. in-dividualizebul gegmasTan SedarebiT upiratesoba jgufSi monawileobas eniWeba. aseve, ZiriTad mizans ar warmoadgens metyvelebis unaris ganviTareba (AAP, 2007).

swavlebis kidev erTi strategia – Bright Start Curricu-lum mimarTulia kognituri unarebis ZiriTadad azrovnebis moqnilobis gaumjobesebaze. swavlebis aRniSnuli gegma ZiriTadad mimarTulia yuradRebis, socialuri interaqci-is, komunikaciiss da motivaciis gaumjobesebaze. aRniSnuli strategiis gamoyenebis faqtobrivi Sedegebis Sesaxeb jer ar aris saTanado informacia (AAP, 2007).

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sxva pervesiuli aSlilobebi

aspergeris sindromi

ra aris aspergeris sindromi?

aspergeris sindromi ganviTarebis darRvevaa, romelic pirvelad aRiwera jer kidev �944 wels avstrieli fsiqiatris H. Asperger-is mier, mas Semdeg, rac L.Kanner-ma gamoaqveyna informacia bavSvTa adreuli autizmis sindromis Sesaxeb. miuxedavad amisa, aspergeris sindroms fsiqologiurma da samedicino sazogadoebam yuradReba mxolod L.Wyng-is (�98�) cnobili statiis gamoqveynebis Semdeg miaqcia.

aRniSnuli sindromis mqone bavSvebs normaluri inte-leqtisa da ganviTarebuli metyvelebis fonze axasiaTebT socialuri urTierTobis deficiti, komunikaciis sirTu-le, wesebisa da ritualebis akviatebuli dacva, ucnauri, eqscentruli qceva.

aspergeris sindromis gavrceleba

sindromi ufro xSirad gvxvdeba mamakacebSi, vidre qa-lebSi da ar aris damokidebuli mSoblebis ganaTlebis do-nesa da socialur-ekonomikur statusze. dazustebuli epi-demiologiuri monacemebi aspergeris sindromis Sesaxeb ar arsebobs. Tumca sxvadasxva kvlevis mixedviT yoveli �0000 adamianidan �0-40 piri akmayofilebs aspergeris sindromis sadiagnostiko kriteriumebs. aseTi didi sxvaoba epidemio-logiur kvlevebSi gamoyenebuli sadiagnostiko kriteriu-mebis gansxvavebiT aris ganpirobebuli.

aspergeris sindromis diagnostika

aspergeris sindromis mqone pirebs, Tavdapirvelad SeiZ-leba, ver daesvas, an arasworad daesvas diagnozi. Cveule-

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briv, pirveladi diagnozia bavSvTa adreuli autizmi, speci-fikuri daswavlis unaris darRveva an akviatebis sindromi.

aspergeris sindromis diagnostikuri kriteriumebi DSM-IV-TR-is mixedviT

A. socialur urTierTobaTa Tvisobrivi darRveva _ vlindeba qvemoT CamoTvlili Semdegi simptomebidan or maTganSi mainc:

�. araverbaluri qcevis gamoxatuli darRveva, rogoricaa social-uri urTierTobisas TvalebiT kontaqti, saxis gamometyveleba, sxeulis poza da Jestebi;

�. TanatolebTan asakobrivi ganviTarebis Sesabamisi urTierTobis damyarebis SeuZlebloba;

3. sxva adamianebTan erToblivi garTobis, saerTo interesebisa da TanamSromlobis spontanuri survilis deficiti;

4. socialuri Tu emociuri reciprokulobis naklovaneba.

B. ganmeorebadi, stereotipuli qcevebi, interesebi, moqmedebebi _ vlindeba qvemoT CamoTvlili simptomebidan erT-erTSi mainc:

�. stereotipuli, SezRuduli, viwro interesebiT Semofargvla, rac xasiaTdeba anomaluri intensivobiTa da Zlieri fokusiT;

�. specifikuri ritualebis zedmiwevniT dacva yoveldRiur cxovre-baSi;

3. stereotipuli da ganmeorebadi motoruli maneruloba (sxeulisa da saxis moZraobebi, xelebisa da TiTebis qneva an triali).

C. es darRvevebi iwvevs socialuri, SromiTi da sxva sazogadoebrivi funqcionirebis klinikurad mniSvnelovan darRvevebs.

D. ar aRiniSneba klinikurad gamoxatuli CamorCena metyvelebaSi (ori wlisaTvis calkeuli sityvebis, sami wlisaTvis _ calkeuli fra-zebis gamoyeneba).

E. ar vlindeba klinikurad gamoxatuli CamorCena kognitur ganviTa-rebaSi, an asakis Sesabamis TviTmomsaxurebis CvevebSi, adaptaciur qcevaSi (socialuri urTierTobis garda) da garemosadmi cnobis-moyvareobaSi.

F. am kriteriums ar akmayofilebs sxva specifikuri pervesiuli darRvevebi da Sizofrenia.

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aspergeris sindromis diagnostikuri kriteriumebi ICD-10-is mixedviT

A. ar aRiniSneba metyvelebis, an kognituri ganviTarebis klinikurad gamoxatuli CamorCena. diagnozi moiTxovs, rom calkeuli sityvebis gamoyeneba or wlamde, xolo komunikaciuri frazuli metyveleba sami wlis asakisaTvis viTardebodes; TviTdaxmareba, adaptaciuri qceva da garemosadmi cnobismoyvareoba normaluri inteleqtual-uri ganviTarebis Sesaferisi iyos. amave dros, am sindromis Sem-TxvevaSi, motoruli ganviTareba CamorCeba asakobriv normas, aRi-niSneba motoruli mouqneloba; xSiria izolirebuli specifikuri Cvevebi, romlebic anomalur viwro interesTanaa dakavSirebuli, Tumca, ar warmoadgens aucilebel diagnostikur kriteriums.

B. reciprokuli socialuri urTierTobis Tvisobrivi darRveva (au-tizmis msgavsi kriteriumi). diagnozi moiTxovs mniSvnelovan dar-Rvevebs Semdegi xuTi sferodan samSi mainc:�. TvalebiT kontaqtis, saxis gamometyvelebis, sxeulis pozisa da

Jestebis adekvaturi gamoyenebis naklovaneba socialuri urT-ierTobis regulaciis mizniT;

�. TanatolebTan interesebis, emociebis gaziarebisa da urTierTobis damyarebis SeuZlebloba (misi gonebrivi asakis Sesabamisi);

3. stresis an distresis dros sxvebisaTvis komfortis SeTavazebisa da TanagrZnobis SeuZlebloba, sxva adamianebisgan daxmarebis miRebis iSviaTi Zieba;

4. sxva adamianebisaTvis siamovnebisa da sixarulis gaziarebis nak-lovaneba;

5. socialur-emociuri reciprokulobis simwire, rac vlindeba sxva adamianebis emociebze reagirebis darRvevaSi; socialuri konteqstis mixedviT qcevis regulaciis naklovaneba, an socialuri, emociuri da komunikaciuri qcevebis susti integracia;

C. SezRuduli qcevebis, moqmedebebisa da interesebis ganmeorebadi, stereotipuli xasiaTi (autizmis msgavsi kriteriumi; amaSi ar Se-dis motoruli maneruloba). diagnozi moiTxovs mniSvnelovan dar-Rvevebs Semdegi eqvsi sferodan orSi mainc:�. yovlismomcveli stereotipuli da SezRuduli interesi;�. specifikuri mijaWvuloba uCveulo obieqtebze;3. akviatebuli miwebeba arafunqcionalur wesebsa da ritua-

lebze;4. stereotipuli da motoruli maneruloba, rac moicavs xelebis/

TiTebis trials, qnevas, an sxeulis rTul moZraobebs;5. SezRuduli interesi obieqtebis nawilebis an saTamaSo masa-

lebis arafunqcionaluri elementebis mimarT (rogoricaa maTi suni, zedapiris teqstura, maT mier gamowveuli vibracia);

6. distresi garemos umniSvnelo cvlilebebis gamo.

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riT xasiaTdeba aspergeris sindromi?

• socialuri urTierToba:socialuri gulgriloba; Seusabamo kontaqti TvalebiT;TanatolebTan pozitiuri urTierTobis damyarebisa

da SenarCunebis SeuZlebloba; sxvisi azris da emociis gaziarebis sirTule; socialuri mimaniSneblebis gamoyenebis naklovaneba;empaTiis da socialuri reciprokulobis naklovane-

ba;dialogis warmoebis sirTule.

• qceva: yoveldRiur cxovrebaSi wesebisa da ritualebis

Seucvlelad dacva; situaciisa da ganrigis odnavi cvlilebis mimarT

Zlieri winaaRmdegoba;sagnebis aratipurad gamoyeneba, sagnebis romelime

nawilisadmi gansakuTrebuli yuradReba;stereotipuli da ganmeorebadi moZraobebi;sakuTari viwro interesis garSemo saubari da mosau-

bris interesis gauTvalisewinebloba.• metyvelebis ganviTareba:

bavSvs adreul asakSi SeiZleba hqondes metyvelebis Se-ferxeba, rasac mohyveba metyvelebis unaris swrafi ganviTa-reba; aseT SemTxvevaSi xSiria hiperleqsia (araCveulebrivad farTo leqsikoni), magram darRveulia metyvelebis prag-matuli mxare _ bavSvi enas ver iyenebs situaciisa da kon-teqstis Sesabamisad, daJinebulad laparakobs akviatebul Temebze. aseT bavSvebs socialuri komunikaciisaTvis me-tyvelebis gamoyenebis problema aqvT da uZneldebaT naTq-vami an dawerili sityvidan mniSvnelobis gamotana, radgan:• ar gaaCniaT dagegmvis, impulsis kontrolis, TviTkontro-

lisa da erTi situaciidan meoreze gadarTvis unari;• SezRuduli aqvT interesebisa da saqmianobis sferoebi _

mxolod maTTvis saintereso Temaze SeuZliaT gauTave-beli saubari, ise rom angariSs ar uweven mosaubris survilsa da interess.

�03

• motoruli mouqneloba: aRniSnuli daficiti vlindeba rogorc msxvil, aseve na-

tif motorikaSi _ bavSvs ar uyvars wera, sportul aqtivo-bebSi CarTva, aqtiuri motoruli TamaSebi. SeiZleba, vlinde-bodes iseTive vizualur-motoruli deficiti, rogoric ax-asiaTebT daswavlis unaris daqveiTebis mqone pirebs.• araverbaluri komunikaciis problemebi vlindeba:Jestebis gamoyenebis simwireSi;mwiri saxis eqspresiaSi;emociis araadekvaturi gamoxatvaSi;sxvisi Jestebis, mimikis, sxeulis enis gagebis Seu-

ZleblobaSi.sainteresoa is faqti, rom Rourke-s araverbaluri das-

wavlis unaris darRvevis cneba mniSvnelovnad faravs as-pergeris sindroms. Rourke Tvlis, rom aspergeris sindro-mis mqone yvela pirs aqvs araverbaluri daswavlis unaris darRveva (Klin, Volkmar 2000).• akademiuri problemebi vlindeba:wakiTxulis gaazrebis problemebSi;mwir organizaciul unarebSi;msjelobisa da daskvnis gamotanis problemebSi;kognitur rigidulobaSi, rodesac problemaa gadarTva

erTi aqtivobidan meoreze, erTi azridan meoreze.

riT gansxvavdeba aspergeris sindromi autizmisgan?

aspergeris sindromi xasiaTdeba farTo speqtris per-vesiuli aSlilobisTvis damaxasiaTebeli niSnebiT; diagno-stikur saxelmZRvaneloebSi igi warmodgenilia rogorc da-moukidebeli nozologia Sesabamisi diagnostikuri krite-riumebiT. miuxedavad amisa, zogierTi mecnieri aspergeris sindroms damoukidebel nozologiad ar Tvlis da miiCnevs, rom igi sxva araferia, Tu ara autizmi (autizmis ioli for-ma) funqcionirebis maRali doniT (fmd) (Szatmari et al., 1986; Klin, 1994). mkvlevrebis interess warmoadgens am ori mdgo-mareobis fenomenologiuri gansxvavebis Zieba. imaze, rom aspergeris sindromi funqcionirebis maRali donis mqone

�04

autizmisagan Tvisobrivad gansxvavebuli nozologiaa, me-tyvelebs Semdegi faqtebi:• veqsleris testSi aspergeris sindromis mqone pirebs

mniSvnelovnad maRali aqvT verbaluri IQ, xolo fmd au-tizmis mqone pirebs _ araverbaluri IQ; amasTan, am uka-nasknels aReniSneba mniSvnelovani gansxvaveba verbalur da araverbalur inteleqts Soris, aspergeris sindro-mis mqone individebisagan gansxvavebiT.

• `gonebis Teoriis~ deficiti, anu sxvisi ganzraxvisa Tu Sinagani mdgomareobis gagebis sirTule aReniSnebaT fmd autizmis mqone pirebs da ara aspergeris sindromis mqo-ne individebs.

• neirofsiqologiuri gamokvlevebiT dadgenilia, rom janmrTel sakontrolo jgufTan SedarebiT, fmd autiz-mis mqone pirebs aReniSnebaT aRmasrulebeli (regula-toruli) funqciisa da verbaluri mexsierebis gamoxa-tuli deficiti, aspergeris sindromis mqone pirebs ki mniSvnelovnad daqveiTebuli aqvT emociis aRqma da re-gulatoruli funqcia.

• autizmisa da aspergeris sindromisaTvis saerTo simp-tomi mxolod aRmasrulebeli (regulatoruli) funq-ciis deficiti aRmoCnda.autizmi heterogenul qvetipebs moicavs da sakiTxi misi

da aspergeris sindromis pirveladi deficitis Sesaxeb jer isev Riad rCeba. dReisaTvis iTvleba, rom aspergeris sin-dromi damoukidebeli daavadebaa, xolo autizmTan Sedare-biT misi gamosavali da prognozi bevrad saimedoa.

unda aRiniSnos, rom autizmisagan gansxvavebiT, asper-geris sindroms bevri ram aqvs saerTo araverbaluri das-wavlis unaris daqveiTebasTan.

rogor SeiZleba davexmaroT aspergeris sindromis mqone bavSvs?

aspergeris sindromis mqone bavSvebs ZiriTadi pro-blemebi socialuri komunikaciis, cvlilebasTan Seguebisa da moqnilobis sferoebSi aqvT, ris gamoc, periodulad,

�05

aReniSnebaT umarTavi qceva; sirTuleebi vlindeba qcevis organizaciaSic. aRniSnulidan gamomdinare:• pirvel rigSi, saWiroa, mozrdilTa didi moTmineba da

bavSvis umarTavi qcevisa Tu sibrazis afeTqebebis swori interpretacia;

• emociis aRqmis deficitis miuxedavad, aseTi bavSvebi Zlier mgrZnobiareni arian laparakis maRali da gaRi-zianebuli tonis mimarT;

• uWirT problemis damoukideblad gadaWra da am dros esaWiroebaT Tanmimdevruli daxmareba;

• aspergeris sindromis mqone bavSvis perseveraciebi gar-SemoyofTaTvis Zalze gamaRizianebelia; stresisa da daZabulobis zrdasTan erTad perseveraciac Zlierdeba. aseT dros bavSvis erTsa da igive SekiTxvaze ganmeore-biTi pasuxebi an imis mtkiceba, rom aRniSnul kiTxvaze ukve upasuxeT, naklebefeqturia. samagierod, efeqtu-ria yuradRebis warmarTva sxva, bavSvis interesebis Se-satyvisi mimarTulebiT;

• bavSvi winaswar unda momzaddes dRis wesrigis mosalod-neli cvlilebisaTvis, radgan moulodneli cvlileba, SeiZleba umarTavi qcevisa da sibrazis afeTqebis mizezi gaxdes;

• miuxedavad imisa, rom aseTi bavSvi gamarTulad me-tyvelebs da kargi leqsikoni aqvs, mas uWirs swrafi da rTuli frazebis Semcveli mimarTuli metyvelebis gage-ba; aseve, uZneldeba ramdenime Tanmimdevruli moqmede-bis gegmis mixedviT warmoeba. amitom ufro efeqturia, martivi, maqsimum orsafexuriani miTiTebebis miwodeba, martivi frazebiTa da neli tempiT saubari;

• araefeqturia erTi da imave miTiTebis bevrjer gameo-reba, umjobesia erTi instruqciis perefrazireba;

• SesaZlebelia, bavSvi mgrZnobiare iyos specifikuri fa-qturis, gemos, xmebisa Tu sunis mimarT, rac mis SfoT-vas iwvevs. amitom, aucilebelia im faqtorebis garkveva, rac win uZRvis umarTav qcevas;

• aspergeris sindromis mqone bavSvi ver itans xmaurian garemos, xalxmraval da sazogadoebrivi TavSeyris ad-gilebs, uWirs sensoruli stimulebis intensivobis mo-

�06

dulacia da kargavs usafrTxoebis grZnobas. es ki iwvevs umarTav qcevas.

• aspergeris sindromis mqone bavSvi gaurbis TvalebiT kontaqts, amitom saubrisas misTvis TvalebSi cqeris daZaleba arasasurvelia; rodesac aseTi bavSvi mo-saubres pirispir ar umzers, ukeT esmis misi da Tavs bevrad mSvidad grZnobs;

• xumrobasa da metaforul gamonaTqvamebs aspergeris sindromis mqone bavSvebi ver gebuloben; miuxedavad le-qsikis mdidari maragisa, SeiZleba, ar esmodeT maTTvis nacnobi sityvis mniSvneloba. amitom, saWiroa, yovelT-vis dazustdes, esmis Tu ara aseT bavSvs wakiTxuli an gamoTqmuli sityvis mniSvneloba.

retis sindromi

ra aris retis sindromi?

retis sindromi neiroganviTarebis darRvevaa. igi xa-siaTdeba ataqsiiT, epilefsiuri gulyrebiT, metyvelebisa da qcevis mZime, Seuqcevadi darRvevebiT. es sindromi pir-velad aRwera avstrielma mecnierma A.Rett-ma �966 wels.

ramdenad xSiria retis sindromi?

retis sindromi iSviaTi paTologiaa; misi gavrcelebis maCvenebelia �:�0-��000-ze. am sindromis mqone yvela cocx-ladSobili pacienti mdedrobiTi sqesisaa, xolo retis sin-dromis mqone mamrobiTi sqesis bavSvebis yvela SemTxvevaSi mkvdradSobadobaa dafiqsirebuli.

rogor xdeba retis sindromis diagnostireba?

retis sindromi pervesiuli ganviTarebis aSlilobad iTvleba. misi diagnostika sakmaod rTulia, radgan dRei-

�07

saTvis ar arsebobs misTvis specifikuri sadiagnostiko markeri; Sesabamisad, SeumuSavebelia diagnostikisaTvis aucilebeli, damxmare da sadiferenciacio kriteriumebi. amitom diagnozis dadgena klinikuri simptomebis mixedviT xdeba. pirveladi diagnozi ori wlis asakamde dgindeba, xolo misi dadastureba oridan xuT wlamde asakis perio-dSi xdeba. swori diagnostikisaTvis aucilebelia rogorc ganviTarebis mTliani profilis mravaljeradi gamokvleva, ise dawvrilebiTi pre- da perinataluri anamnezi.

klinikuri aRweris mixedviT retis sindromi oTxi fa-ziT mimdinareobs: normaluri ganviTarebis faza _ dabade-bidan 6 Tvemde, 6 Tvidan wlamde aRiniSneba stagnaciis faza, regresis faza, destruqciuli faza _ sicocxlis �-dan 4 wlamde, plato _ �-dan �0 wlamde da gviandeli, motoruli gauaresebis faza _ �0 wlis asakidan.

riT xasiaTdeba retis sindromi?

retis sindromiT daavadebulTa ganviTareba dabadebi-dan eqvs Tvemde fiziologiuri normis farglebSia da isini janmrTeli bavSvis STabeWdilebas toveben.

eqvsi Tvidan iwyeba ganviTarebis Seferxeba da manamde SeZenili Cvevebis ukuganviTareba; qveiTdeba mobiluroba, TamaSis iniciativa, TvalebiT kontaqtis intensivoba, matu-lobs kunTTa tonusi, xelebis mizanmimarTuli qmedebebi icvleba uazro, stereotipuli moZraobebiT da manifes-tirdeba gulyrebi. eqvsi Tvidan erT wlamde asakSi saxezea ganviTarebis stagnacia. vinaidan urTierTobaSi aseTi bavS-vebi adekvaturebi da kontaqturebi arian, mSoblebi Tavs imSvideben, rom bavSvi daeweva ganviTarebis asaks.

stagnaciis Semdeg iwyeba regresis faza, romelic Tan-xlebulia piramiduli da eqstrapiramiduli niSnebiTa da Zvlovani sistemis arasrulfasovnebiT, rac gamoixateba Zvlovani qsovilis zrdis tempis SenelebiTa da SeCerebiT (mikrocefalia, sqoliozi). regresis faza, romelic grZel-deba sicocxlis 30-e Tvemde, SeiZleba, eqvsi Tvis asakidanve daiwyos da axasiaTdebdes ganviTarebis uecari an Tanda-

�08

TanobiTi daqveiTeba; xelebis manipulaciuri moZraoba da metyvelebis unari yovelTvis qveiTdeba. natifi motorikis SemTxvevaSi, TiTebis ukve Camoyalibebuli pincetiseburi moZraoba TandaTanobiT qreba. matulobs xelebisa da ta-nis stereotipuli, biZgiseburi moZraobebi; bavSvi xelebs mudmivad pirSi idebs an zurgsukan aqvs gadajaWvuli da iS-viaTad iyenebs maT. xelebis stereotipuli moZraobebi qre-ba Zilis dros. aseTi saxis moZraobebi xels uSlis bavSvis mizanmimarTuli moqmedebis mcdelobas, rac iwvevs bavSvis Zlier agznebas. agznebis Semcireba SesaZlebelia nebismieri moqmedebis garedan warmarTviTa da regulaciiT. am fazaSi-ve vlindeba kognituri funqciebis ganviTarebaSi CamorCena, autisturi tipis qcevebi, socialuri urTierTobebisa da komunikaciis darRveva.

asakis matebasTan erTad, aRmocendeba sunTqvis pro-blemebi: Zilis dros sunTqva normaluria, xolo ucabedi gaRviZebis dros viTardeba hiperventilacia/apnoes cikli. gamoRviZebisas xSiria sunTqvis dizriTmia, rac, ZiriTadad, kidurebisa da tanis ganmeorebiTi moZraobebis sixSiris zr-das ukavSirdeba.

am fazaSi, aseve, aRmocendeba araepilefsiuri paroq-sizmebi afeqtur-respiratoruli Setevebis saxiT, romleb-sac Tan axlavs cianozi da distoniuri poza. epilefsiuri gulyrebi ki oTxi wlis asakidan iwyebs manifestirebas. miu-xedavad imisa, rom retis sindromis mqone yvela bavSvs aqvs paTologiuri eeg-paternebi, epilefsiuri gulyrebi klini-kurad aReniSneba mxolod maT 50%-s. sindromi xasiaTdeba sxvadasxva tipis epilefsiuri gulyrebiT: atipuri absanse-bi, parcialuri, pirveladad generalizebuli da meoradad generalizebuli gulyrebi, romlebic TiTqmis ar eqvemde-bareba antiepilefsiur mkurnalobas.

mesame faza _ plato xasiaTdeba apraqsiiT, motoruli problemebiTa da epilefsiuri gulyrebiT. amavdroulad, mesame fazaSi umjobesdeba qceva, mcirdeba autisturi niS-nebi. am periodSi izrdeba garemosadmi bavSvis interesi; SeiZleba, gaumjobesdes komunikacia da yuradReba.

meoTxe _ gauaresebis faza, ZiriTadad, xasiaTdeba mo-Zraobis darRvevebis gaRrmavebiT. asakis matebasTan erTad

�09

Zlierdeba sqoliozi, kunTebis spastiuroba, ferxdeba si-maRleSi zrda, Zlierdeba kunTebis rigidoba da matulobs kunTTa tonusi, irRveva sxeulisa da kidurebis poza, Ti-Tqmis SeuZlebeli xdeba siaruli. Tumca, mcirdeba xelebis stereotipuli moZraobebi da umjobesdeba TvalebiT kon-taqti. am fazaSi kognituri sferos Semdgomi regresi ar SeiniSneba.

ra aris retis sindromis mizezi?

retis sindromis etiologiis yvelaze gavrcelebuli hipoTezaa genetikuri _ autosomur-dominanturi X qromo-somis mutacia. mamis mxridan gadacemuli X-qromosomuli mutaciis SemTxvevaSi, daavadebis gamosavali yovelTvis le-taluria. dedis xaziT genuri mutaciis gadacemis Sesaxeb metyvelebs naTesaobaSi erTi dedis qaliSvilebis (naxevar debis), deidisa da disSvilis erTdrouli avadobis aRweri-li SemTxveva. retis sindromis mqone � pacientia aRwerili qromosomuli translokaciiT: pirvels hqonda X qromoso-mis mokle mxrisa (P��.��) da me-3 qromosomis balansirebuli translokacia; meore pacients translokacia aReniSneboda X (P��.��) da X (P��.��) mxrebs Soris. aseTive qromosomu-li paterni gamouvlinda atipuri niSnebis mqone pacientis janmrTel dedasa da das.

�99� wels A. Byrd-ma aRmoaCina X qromosomis MECP-2 geni, romlis mutaciac MECP-2 cilis inaqtivacias iwvevs, rac dReisaTvis retis sindromis yvelaze aRiarebul mize-zadaa miCneuli.

aseve, gavrcelebulia neiroqimiuri hipoTeza. gamokv-levebis mixedviT, retis sindromis mqone pacientebs Tavis tvinSi aReniSnebaT dofamin-�-is receptorebis mniSvnelo-vani Semcireba da sakmaod daqveiTebuli aqvT qolin-ace-til-transferazis done. am sindromis SemTxvevebSi, auto-fsiuri gamoklvevebiT dafiqsirda Tavis tvinis mcire wona, Tumca, tvinis TeTr nivTierebaSi aranairi cvlilebebi ar aReniSneboda.

��0

bavSvobis dezintegraciuli aSliloba

ra aris bavSvobis dezintegraciuli aSliloba?pirvelad es mdgomareoba aRwera helerma �908 wels,

amitom mas xSirad heleris sindromsac uwodeben. dezinte-graciuli aSliloba pervesiuli aSlilobebis jgufs mieku-Tvneba, magram autizmisgan gansxvavdeba imiT, rom anamnezSi saxezea bavSvis adreuli normaluri ganviTareba, romelic SemdgomSi regresirebs. zogierTi mkvlevari Tvlis, rom es bavSvobis demenciaa, Tumca misi damadasturebeli paTofi-ziologiuri mtkicebulebebi naklebad misawvdomia.

ramdenad xSiria bavSvobis dezintegraciuli sindromi?

aRniSnuli mdgomareoba iSviaTia: � : �00 000 bavSvze. Tu-mca, sxvadasxva qveynis epidemiologiuri monacemebi sakma-od mwiria. iTvleba, rom biWebSi aRniSnuli sindromi ufro xSiria gogonebTan SedarebiT, magram zusti monacemebi ar arsebobs.

riT xasiaTdeba bavSvobis dezintegraciuli aSliloba?

bavSvis ganviTarebis istoria, rogorc wesi normalu-ria 3-4 wlamde da am periodidan iwyeba uecari an Tanda-TanobiTi daqveiTeba. mSoblebi da pediatrebi aRniSnaven bavSvis metyvelebis da araverbaluri komunikaciis Cveule-briv ganviTarebas, asakisaTvis Sesaferis TamaSs, emociur da SemecnebiT ganviTarebas. 3-4 wlidan mSoblebi amCneven, rom bavSvi uecrad an TandaTanobiT kargavs metyvelebis SeZenil unarebs, SeZenil Cvevebs, Tavs iCens emociuri da socialuri problemebi.

DSM-IV-TR-is diagnostikuri kriteriumebis mixedviT aRiniSneba:

a. normaluri ganviTareba pirveli � wlis ganmavlobaSi, rac vlindeba asakis Sesabamis metyvelebis da komu-nikaciur unarebSi, TamaSSi, adaptaciur qcevebSi.

��

b. ukve SeZenil CvevebSi mniSvnelovani daqveiTeba aRi-niSneba Semdeg sferoebSi• eqspresiul metyvelebaSi;•receptul metyvelebaSi;•socialur CvevebSi;•tualetis CvevebSi;•TamaSSi;• motorul CvevebSi.

g. funqcionorebis darRveva Semdegi sferoebidan �-Si mainc:

(�) socialuri urTierTobis Tvisobrivi darRveva (mag. ara-verbaluri urTierTobis, sxva bavSvebTan urTierTobis damyarebis, socialuri da emociuri reciprokulobis);

(�) komunikaciis Tvisobrivi darRveva (mag. metyvelebis gan-viTarebis daqveiTeba, sxvasTan saubris SeuZlebloba, metyvelebis stereotipuli gamoyeneba, simboluri Ta-maSis SeuZlebloba);

(3) stereotipuli, ganmeorebiTi da mwiri qceviTi pater-nebi, SezRuduli interesebi da moqmedebebi motoruli stereotipebisa da manerizmebis CaTvliT.d. aRniSnuli darRvevebi ver aixsneba sxva specifikuri

pervesiuli aSlilobiT an Sizofreniis arsebobiT.sxva mxriv, bavSvobis dezintegraciuli aSliloba xasia-

Tdeba pervesiuli ganviTarebis aSlilobisaTvis damaxasia-Tebeli yvela niSniT, Tumca ufro gamoxatulia SiSebi da adreuli stereotipuli qcevebi.

aRniSnul sindroms xSirad Tan axlavs gamoxatuli go-nebrivi CamorCeniloba, Tumca ara yovelTvis. am dros, au-tizmTan SedarebiT ufro xSiria Tavis tvinis eleqtroen-cefalografiuli cvlilebebi da gulyrebi.

ra mizezebi iwvevs bavSvTa dezintegraciul aSlilobas?

aRniSnuli sindromis etiologiuri faqtori da paToge-nezuri meqnizmebi dReisaTvis ucnobia. amave dros, zogier-Ti kvleva miuTiTebs genetikur faqtorebze da prenatalu-rad moqmed garemos risk-faqtorebze, romelTa erTobli-

��

vi zemoqmedeba SesaZloa iwvevs Tavis tvinSi amiloiduri grovebis aRmocenebas da Sesabamisad sinafsuri gadacemis darRvevas (Bernstein et al., 2004).

garemos faqtorebidan yvelaze xSirad aRniSnaven:• virusebs (toqsoplazmozi, wiTura, citomegalovirusi,

herpes simpleqsvirusi)• toqsinebis mavne zemoqmedebas;• dabadebis travmas;• qvemwvave masklerozirebel panencefalits – mdored

mimdinare qronikuli infeqcia, romelic gamowveulia Cutyvavilis virusiT da azianebs Tavis tvinis neironebs.genetikuri faqtorebidan aRniSnaven sxvadasxva meta-

bolur darRvevebs, magram ufro xSirad lipidebis cvlis darRvevas.

aseve, xSirad aRniSnaven Tanmxleb autoimunur daaavade-bebs, alergias da asTmas.

rogor xdeba bavSvobis dezintegraciuli aSlilobis diagnostireba?

klinikuri diagnozi ismeba ganviTarebis Sesaxeb anam-nezisa da diagnostikuri kriteriumebis safuZvelze. amave dros, mniSvnelovania diferencialuri diagnostireba ise-Ti mdgomareobebisagan, rogoricaa:retis sindromi;eqspresiul-receptuli metyvelebis Sereuli darRveva;gonebrivi CamorCeniloba, gamowveuli tyviiT mowa-

mvliT, iodis deficitiT an hipoTireoziT, mZime liTo-nebiT intoqsikaciiT;

aminoaciduria;Tavis tvinis simsivne;neirodegeneraciuli daavadebebi;epilefsia, landau-klefneris sindromi;aiv infeqcia.

samedicino diagnostirebisaTvis mizanSewonilia:Tiroiduli funqciis gamokvleva (T3, T4,TSH sinjebi); Tirkmlis funqciis gamokvleva;skriningi mZime liTonebze;testi aiv infeqciaze;

��3

aminoacidopaTiis skriningi;Tavis tvinis neirovizualuri gamokvleva simsivnis ga-

mosaricxad;RviZilis da Zilis eeg epilefsiis gamosaricxad;qromosomuli analizi genetikuri sindromebis gamosa-

ricxad.bavSvis detalur nevrologiur gamokvlevasTan erTad

aucilebelia misi ganviTarebis da pervesiuli aSlilobis damaxasiaTebeli niSnebis fsiqologiuri Sefaseba. rogoria daxmareba bavSvobis dezintegraciuli aSlilobis dros?

pirvel rigSi aucilebelia swori diagnostika, rac bavS-vis multidisciplinur Sefasebasa da zemoaRniSnul gamokv-levebs moiTxovs. bavSvs afaseben bavSvTa nevrologi, fsiqia-tri, neirofsiqologi, okupaciuri Terapevti, logopedi.

aucilebelia mSoblebis fsiqologiuri konsultacia da ganaTleba bavSvis diagnozis misaRebad, dardisa da stresis dasaZlevad da realuri daxmarebis misaRebad. aseve, mniSvne-lovania mSoblebis swavleba Tu rogor unda eTamaSon bavSvs, rogor daicvan dRis reJimi, rogor Seuwyon xeli mis gan-viTarebas. mkurnaloba, rCevebi, intervenciis strategiebi, ganaTlebisa da daxmarebis meTodebi autizmis analogiuria.

mkurnaloba simptomaturia da ZiriTadad mimarTulia qceviTi da emociuri aSlilobis simptomebze neirolepti-kebiT da serotoninis seleqciuri inhibitorebiT.

rogoria bavSvis ganviTarebis prognozi?

SeZenili Cvevebis daqveiTeba da dakargva umetes Se-mTxvevaSi garkveul platos aRwevs da Semdeg SesaZloa iyos umniSvnelo gaumjobeseba. ufro iSviaTia SeZenili Cvevebis progresuli darRveva. mdgomareoba qronikuli xasiaTisaa da Tan axlavs qceviTi da kognituri funqcionirebis gamo-xatuli darRvevebi.

gulyrebis riski matulobs asakTan erTad da piks aRwevs mozardobis asakSi. serotoninis seleqciuri inhibitorebi

��4

da neiroleptikebi kidev ufro aqveiTeben gulyris zRur-bls da zrdian gulyris aRmocenebis albaTobas.

gonebrivi CamorCenilobis Zlieri xarisxi, metyvelebis komunikaciuri mizniT gamoyenebis SeuZlebloba mniSvnelo-vnad auaresebs prognozs.

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qala-tvinis travma

ra aris qala-tvinis travma?

qala-tvinis travma aris gare fizikuri ZaliT gamowveu-li Tavis tvinis SeZenili dazianeba, rac araxelsayrel gav-lenas axdens pirovnebis SemecnebiT, komunikaciur Tu emo-ciur-motivaciur sferoze. termini qala-tvinis travma gu-lisxmobs Tavis qalas Ria, an daxuruli dazianebis Sedegad gamowveul Semdegi erTi an ramdenime sferos gauaresebas, rogoricaa metyveleba, mexsiereba, yuradReba, abstraqtu-li azrovneba, sensoruli, perceptuli da motoruli una-rebi, somaturi funqciebi, fsiqo-socialuri qceva.

qala-tvinis travmis Sedegad, SeiZleba, daziandes Tavis qala, tvinis qsovili, an sisxlZarRvovani sistema. SeiZleba, adgili hqondes Tavis qalas Zvlebis motexilobas, hemato-mas, tvinis kontuziasa da SeSupebas, qalasSida wnevis moma-tebas, intracerebrul hemoragias (sisxlis Caqceva). qala-tvinis travmis xarisxi damokidebulia dazianebis xarisxsa da darRvevebis sirTuleze. gamoyofen msubuq _ trivialur travmebs, saSualo xarisxis, mZime da umZimes travmebs. ga-nasxvaveben qala-tvinis travmis Ria da daxurul formebs. yvelaze gavrcelebul formas Tavis tvinis daxuruli tra-vmebi warmoadgens. am tipis dazianeba araa Tanxlebuli qa-las Zvlebis motexilobebiT, an tvinis magari garsis dazia-nebiT. daxurul travmebSi gamoyofen: Tavis tvinis Seryevas (comotio cerebri), kontuziastvinis kompresias.

Ria travmas Tan axlavs Tavis qalas Zvlebis motexiloba. travmis Semdgomi gamojansaRebis periodi SeiZleba

daiyos mwvave, qvemwvave da grZelvadian periodebad. msu-buqi dazianebis dros aseTi periodebis gamoyofa ar xdeba; SedarebiT mZime travmebis SemTxvevebSi yoveli periodisa-Tvis gansazRvruli droiTi monakveTi ar arsebobs da maTi xangrZlivoba damokidebulia rogorc pacientis asakze, ise travmis xarisxze. Tumca, zogadad: mwvave periodi, SeiZle-ba, ramdenime Tvemde gagrZeldes, qvemwvave periodi _ 3-

��6

6 Tvidan � wlamde, xolo grZelvadiani periodi travmis miRebidan erTi wlis Semdeg daiwyos. qala-tvinis travmas, xSirad, `mdumare epidemias~ uwodeben, vinaidan qala-tvinis dazianebis Semdeg bavSvs, SeiZleba, didxans ar gamouvlin-des simptomebi. qala-tvinis travmis dazianebis simptomebi mravalferovania da damokidebulia Tavis tvinis dazianebis xarisxsa da lokalizaciaze.

gamoyofen, agreTve, perinatalur (mSobiarobis periodis) travmul dazianebas. mSobiarobis procesSi didi mniSvnelo-ba aqvs, Tu rogor gaivlis nayofi samSobiaro arxs da rogor daibadeba. travmis riski izrdeba iseTi faqtorebis gavle-niT, rogoricaa araelastiuri samSobiaro arxi, didi wonis nayofi, patara zomis saSo, an nayofis araswori mdebareoba.

riT xasiaTdeba qala-tvinis travma?bavSvis ganviTarebaze qala-tvinis travmis zegavlena da-

mokidebulia asaksa da travmis xarisxze. rac ufro adreul asakSi viTardeba travma da Zlieria dazianebis xarisxi, miT ufro met zegavlenas axdens bavSvis ganviTarebaze. travmis dros bavSvma, SeiZleba, goneba dakargos (komatozuri mdgo-mareoba), an SeiZleba, aReniSnos post-travmuli amnezia (me-xsierebis dakargva) da drosa Tu garemoSi dezorientacia. qala-tvinis travmis gadatanis Semdeg bavSvebs, SeiZleba, problemaTa mTeli kompleqsi aRmoucendeT:• fizikuri mdgomareobis gauareseba: Tavis tkivilebi,

kunTTa tonusis cvlilebebi, kidurebis parezi an dam-bla erT an orive mxares, wonasworobisa da siarulis darRvevebi, natifi motoruli koordinaciis gauarese-ba, mxedvelobiTi, smeniTi an sxva saxis sensoruli ana-lizatoruli sistemis gauareseba, gulyrebi.

• SemecnebiTi sferos gauareseba: xanmokle da xangrZlivi mexsierebis darRvevebi, yuradRebis kontrolis gauare-seba, azrovnebis procesis Seneleba, aRqmis, metyvele-bis, kiTxvis, weris, moqmedebis dagegmvis gauareseba.

• fsiqo-socialuri, qceviTi, emociuri darRvevebi: swrafi daRla, guneba-ganwyobis meryeoba, SfoTva, impulsuro-ba, emociuri kontrolis sisuste, dabali TviTSefaseba,

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depresia, apaTia.darRvevebi yovel sferoSi gansxvavebuli xarisxiT

vlindeba. maTi simZime damokidebulia dazianebis buneba-ze, xarisxze, bavSvis asakze, komis arsebobis SemTxvevaSi _ mis xarisxze, romlis siRrme da xangrZlivoba gansazRvravs tvinis dazianebis xarisxs.

ra mizezi iwvevs qala-tvinis travmas? Tavis tvinis travmis yvelaze gavrcelebuli mizezebia

satransporto ubeduri SemTxvevebi, fizikuri Zaladobis, Cxubis SemTxvevebi, samSobiaro travmebi, varjiSis dros momxdari dazianeba, bavSvis dacema, simaRlidan Camovardna.

ra sixSiriT gvxvdeba qala-tvinis travma?aSS jandacvis saministros monacemebiT yovelwliurad

erTi mln. bavSvi iRebs qala-tvinis travmas, romelTagan hos-pitalizacia aucilebelia �65 000 SemTxvevaSi. daxurul tra-vmebze modis qala-tvinis travmis SemTxvevaTa 83.5%. Tavis tvinis ioli dazianeba ufro xSiria, vidre mZime; ioli tra-vmis SemTxvevaSi arc mimarTaven samedicino samsaxurs. msu-buqi dazianeba gvxvdeba �9 wlamde aRweril SemTxvevaTa 89% da erT wlamde asakis SemTxvevaTa 76%-Si. dazianebis sixSire mamakacebSi ufro maRalia, vidre qalebSi. asakobrivi Tvalsa-zrisiT qala-tvinis travmebi yvelaze xSiria �-dan �� wlamde _ 87%. aqedan, 7-�� wlis asakis bavSvebze modis maTi 48%. mi-zezis TvalsazrisiT yvelaze xSiria, bavSvebis sxvadasxva si-maRlidan vardna, Semdeg _ satransporto SemTxvevebi (saavto-mobilo, motocikletis, velosipedis) da maTTan SedarebiT iSviaTia fexiT mosiaruleTa ubeduri SemTxvevebi.

ra ZiriTadi problemebi gvxvdeba qala-tvinis travmis dros?

bavSvebSi qala-tvinis travmis Sedegebs arTulebs is ga-remoeba, rom centraluri nervuli sistema maT jer kidev srulyofilad ara aqvT Camoyalibebuli da ganagrZobs gan-

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viTarebas. amitom, SesaZlebelia, qala-tvinis travmis simp-tomebi gamoCndes ara uSualod dazianebis Semdeg, aramed mogvianebiT, rodesac dgeba travmis Sedegad dazianebuli sistemebis momwifebisa da aqtivobis periodi.

problemebi, yvelaze xSirad, bavSvebs, SeiZleba, gamou-vlindeT Semdeg sferoebSi:• inteleqtualuri unarebis daqveiTeba mniSvnelovan ka-

vSirSia komisa da post-travmuli amneziis xangrZlivo-basTan. umcrosi asakis bavSvebSi (�-8w) inteleqtualuri unarebis deficiti ufro mZafria, vidre ufrosi asakis bavSvebSi (9-�8w). msubuqi da saSualo xarisxis travmebis mqone bavSvebSi inteleqtualuri unarebi umjobesdeba asakis matebis paralelurad.

• travmis Semdeg yvelaze xSiria mexsierebisa da yuradRe-bis problemebi. bavSvs, SeiZleba, problemebi hqondes xanmokle mxedvelobiT da smeniT-verbalur mexsiereba-Si, yuradRebis koncentraciasa da gadanacvlebaSi.

• miuxedavad imisa, rom klasikuri afaziis (metyvelebis moSlis) sindromi bavSvebSi iSviaTia, qala-tvinis trav-mis Semdeg xSirad vlindeba metyvelebis sxvadasxva sa-xis paTologia, gansakuTrebiT, perinataluri travmebis Semdeg. aseTi bavSvi gvian iwyebs luRluRs, laparaks, damaxinjebiT metyvelebs, aqvs sityvebis mwiri maragi, uWirs winadadebaSi azris Camoyalibeba, sagnebis saxel-deba, mimarTuli metyvelebis gageba.

• Tavis tvinis lokaluri dazianebisas xSiria mxedve-lobiT-sivrciTi funqciebis ganviTarebis deficitis an darRvevis niSnebi: bavSvs problemebi aqvs xatvaSi, kopirebaSi, sivrciTi mimarTebebis garCevaSi, sivrciT orientaciaSi, sakuTari sxeulis mxareebis orientacia-Si, konstruqciebis agebaSi.

• sxvadasxva xarisxis qala-tvinis travmis mqone bavSvebs aReniSnebaT sensomotoruli unarebis gardamavali, an mdgradi deficiti: uWirT TiTebis swrafi, moqnili, Tan-mimdevruli da SeTanxmebuli moZraobebi, xelebis natifi moZraobebi, sagnebis taqtiluri cnoba, formebis garCeva.

• saSualo da mZime xarisxis travmebis SemTxvevaSi xSiria qceviTi problemebi, rac, SeiZleba, vlindebodes iyos

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impulsurobiT, arastabiluri emociuri mdgomareobiT, post-travmuli stresis sindromiT, gansakuTrebiT mZime katastrofebis Semdeg. iol travmasTan SedarebiT, mZi-me travmis dros intensiuri aRdgena mimdinareobs ufro xangrZlivi drois (�� Tvis) ganmavlobaSi; mZime travmebis Sedegad aRmocenebuli adaptaciuri qcevis darRvevebi, SeiZleba, or welze meti xnis, kognituri funqciebis aRdgenis procesi ki 4-5 wlis manZilze gagrZeldes.

qala-tvinis travmis Sedegad aRmocenebuli swavlis problemebis diagnostikuri kriteriumebi

DSM-4

qala-tvinis travmasTan dakavSirebuli amnesturi sindromi

mexsierebis darRvevis ganviTareba, rac vlindeba axali informaciis daswavlisa da adre daswavlili informaciis aRdgenis unaris daqveiTebaSi.

mexsierebis darRveva iwvevs socialuri da SromiTi cxovrebis mniSvnelovan darRvevebs da adamianis funqcio-nirebis donis mniSvnelovan daqveiTebas.

mexsierebis aseTi darRveva ar vlindeba mxolod al-cheimeris daavadebis an sxva demenciebis dros.

daavadebis istoriisa da samedicino-klinikuri gamokv-levebis safuZvelze organuli dazianebis arseboba garda-maval an qronikul darRvevad ganisazRvreba, Tu mdgoma-reoba � Tveze nakleb, an xangrZlivi periodis ganmavlobaSi mimdinareobs.

ICD-10

organuli amnesturi sindromiuaxloes da Soreul warsulze mexsierebis gamoxatuli

darRvevebis sindromi.diagnozisaTvis aucilebelia dadgindes:

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• mexsierebis darRvevis arseboba: axali masalis daswav-lis unaris darRveva, anterograduli da retrogradu-li amnezia, warsuli gamocdilebisa da STabeWdilebebis gaxsenebis unaris daqveiTeba;’

• insultis an Tavis tvinis daavadebis istoria;• uSualo aRdgenis, an yuradRebisa da cnobierebis de-

feqtebis, zogadi inteleqtualuri deficitis ararseboba.konfabulaciebis, emociuri cvlilebebis, moqmedebis

kontrolis defeqtebis arseboba ar aris aucilebeli, ma-gram miuTiTebs aRniSnul diagnozze.

rogor SeiZleba davexmaroT qala-tvinis travmis mqone bavSvebs? • xSir SemTxvevaSi, ioli qala-tvinis travmis dros eqims ar

mimarTaven, radgan bavSvebSi ioli travmis uSualo Sede-gebi cxadad ar Cans. bavSvs, SeiZleba, mxolod garkveuli periodis Semdeg hqondes Tavis tkivilis, swrafi daRlis Civilebi, Cveulebrivze metad gamoexatos agzneba, dau-qveiTdes saskolo moswreba. ojaxis wevrebisa da maswav-leblisaTvis Zalian rTulia uecrad aRmocenebuli swav-lis problemebi ramdenime Tvis win momxdar SemTxvevas daukavSiron da bavSvs aRiqvamen rogorc celqs, negati-urs, an gazarmacebuls, maSin rodesac, bavSvs aucile-blad esaWiroeba nevrologis konsultacia.

• qala-tvinis saSualo da mZime xarisxis travmis mqone bavSvebisaTvis aucilebelia hospitalizacia. mwvave periodSi maT esaWiroebaT saswrafo gadaudebeli dax-mareba, intensiuri mkurnaloba da specializebuli sa-medicino meTvalyureoba.

• qala-tvinis saSualo xarisxis travmis mqone bavSvebs es-aWiroebaT aqtiuri reabilitacia, xolo mZime xarisxis SemTxvevaSi mravalmxrivi da xangrZlivi reabilitacia. travmiT gamowveuli darRvevebis aRdgenis procesSi mniSvnelovania fizikuri, fsiqologiuri da garemo faqtorebis roli. vinaidan, mZime dazianebis dros, ZiriTadi roli fizikur faqtorebs eniWeba, Sesabam-

��

isad, pirveli rigis amocanas warmoadgens gadaudebeli da intensiuri samedicino daxmareba, bavSvis fizikuri mdgomareobis dinamikaSi Sefaseba, mwvave da qvemwvave periodebSi samedicino meTvalyureoba; SemdgomSi, gan-sakuTrebiT maSin, roca SesamCnevi xdeba kognituri da motoruli deficiti, wina planze gamodis fsiqologi-uri da socialuri garemos problemebi. aucilebelia, ojaxis wevrebisa da specialistebis (eqimis, neirof-siqologis, metyvelebis Terapevtis, fizikuri Terape-vtis, pedagogis) erToblivi muSaoba.

• ioli da saSualo xarisxis travmis dros, arsebiTi Sei-Zleba iyos fsiqologiuri da garemos socialuri faq-torebi: daRliloba, swrafi gamofitva, SfoTva, emoci-uri aramdgradoba, qcevis problemebi, swavlis prob-lemebi, saswavlo garemosTan, ezosa da skolis bavS-vebTan urTierTobis problemebi.

• didi mniSvneloba aqvs bavSvis dRis reJimis SemuSave-bas, romelic mkacrad unda iyos daculi; misi mizania bavSvis Cveuli aqtivobisa da datvirTvis donis Tan-daTanobiTi miRweva datvirTvis dozisa da davalebaTa sirTulis nabij-nabij gazrdiT. dRis reJimi aucile-blad unda SemuSavdes eqimTan da fsiqologTan konsul-taciis safuZvelze. aucilebelia bavSvis mdgomareobis gaTvaliswineba da misdami ojaxis wevrebis adekvaturi damokidebulebis Camoyalibeba.

SeiZleba Tu ara qala-tvinis travmis gankurneba?sruli gamojanmrTeleba damokidebulia travmis xa-

risxze. ioli travmis SemTxvevaSi bavSvi, xSirad, specia-luri mkurnalobis gareSec gamojanmrTeldeba. saSualo xarisxis travmas, mwvave da postmwvave periodSi esaWiro-eba mkurnaloba da eqimis meTvalyureoba. aseT SemTxveveb-Si bavSvi, xSirad, sruliad gamojanmrTeldeba specialuri sareabilitacio daxmarebis gareSec. rac Seexeba mZime da umZimes travmebs, aseT dros aucilebelia intensiuri same-dicino mkurnaloba da neirofsiqologiuri reabilitacia. gamojanmrTelebis prognozi damokidebulia bevr faqtor-ze da Zalian individualuria.

��

qala-tvinis travmis mwvave da postmwvave periodSi aucilebelia bavSvis hospitalizacia, gadaudebeli same-dicino daxmareba da Tu saWiroa (hematomis SemTxvevaSi), qirurgiuli Careva. bavSvis mdgomareobidan gamomdinare, postmwvave periodSi, SeiZleba, saWiro iyos medikamenturi mkurnalobis gagrZeleba, fizikuri Terapia da metyvelebis problemebis SemTxvevaSi _ metyvelebis Terapia.

travmis simZimis mixedviT gamojansaRebis xangrZliv pe-riodSi bavSvs, SeiZleba, dasWirdes specialuri neiro-sa-reabilitacio RonisZiebebis Catareba. travmiT gamowveuli swavlisa da qcevis problemebis daZlevis mizniT, aucile-beli xdeba specialuri saswavlo programis SemuSaveba, rig SemTxvevaSi ki _ bavSvTan individualuri muSaoba.

zogierT bavSvs travmidan xangrZlivi periodis Semdegac esaWiroeba preparatebis miReba gulyrebis kontrolis, yu-radRebis koncentraciis gaumjobesebis, SfoTvis Semcirebis mizniT. amitom aseTi bavSvebisaTvis aucilebelia nevropa-Tologisa da neirofsiqologis perioduli konsultaciebi.

rogor vaswavloT qala-tvinis travmis mqone bavSvs?xSirad, maswavleblebs ara aqvT srulyofili informa-

cia gadatanili qala-tvinis travmis mqone bavSvebis Sesa-Zleblobebis Sesaxeb. travmis aRdgenis procesi ukve saa-vadmyofoSi stacionirebisTanave iwyeba; travmis Semdgomi aRdgeniTi procesis gagrZleba ki skolis pirobebSi mi-mdinareobs. travmis Semdeg zogierTi bavSvi swrafad aRid-gens janmrTelobas, xSirad ki aRdgenis procesi Tveebi da wlebic grZeldeba. Zalian mZime SemTxvevebSi sruli gamo-janmrTeleba ver xerxdeba da garkveuli darRvevebi qroni-kul xasiaTs Rebulobs.

darRveuli fsiqikuri funqciebis aRdgenis prognozi-reba Zalze rTulia. yovel konkretul SemTxvevaSi fsiqi-kuri funqciebis aRdgena damokidebulia rogorc travmis simZimesa da asakze, aseve dazianebamde bavSvis gonebrivi unarebis ganviTarebis doneze da ojaxur garemoze.

gamojanmrTelebis Semdeg, skolaSi wasvlis win, mizan-Sewonilia neirofsiqologisa da metyvelebis Terapevtis

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mier bavSvis konsultireba. maTi dakvirvebisa da gamokvle-vis Sedegebi sasargeblo informacias iZleva maswavlebli-saTvis bavSvis unarebis Taobaze. Tu bavSvi individualur programas saWiroebs, misi SemuSavebac aRniSnuli informa-ciis safuZvelze unda moxdes.

rodesac bavSvi travmis Semdeg skolaSi brundeba, misi mdgomareoba gansxvavdeba travmamdeli mdgomareobisagan. zogjer, metyvelebisa Tu mxedvelobiT-sivrciTi funqcie-bis sul mcire, TiTqmis SeumCnevelma deficitma, SeiZle-ba, daswavlis problemebi Seqmnas; swavlisa da saswavlo si-tuaciasTan xelaxla Seguebis sirTuleebi ki emociur da fsiqo-socialur problemebs qmnis. amitomaa mniSvnelovani saskolo moTxovnebisa da molodinebis misadageba bavSvis SesaZleblobebTan da moTxovnilebebTan. travmis Semdeg bavSvisaTvis gansakuTrebiT Znelia yuradRebis didi xniT koncentracia, radgan igi swrafad ifiteba da gakveTilis dasasrulisaTvis uZneldeba masalis aTviseba. mas didi dro sWirdeba davalebis Sesasruleblad, uWirs gadarTva; aviwy-deba dRis ganmavlobaSi momxdari ambebi, bevrjer sWirdeba masalis gameoreba, radgan xanmokle mexsierebis problemebi aqvs; mZime travmis Semdeg, SeiZleba, metyvelebis proble-mebic gamovlindes.

perinataluri travmis mqone bavSvebs Cvilobis asakidan-ve esaWiroebaT ganviTarebis specialuri programebi, rac bevrad amcirebs maT saskolo problemebs.

saskolo asakSi miRebuli qala-tvinis travmis Semdgom bavSvis swavlis procesSi aucilebelia Semdegi miTiTebebis gaTvaliswineba:

• davalebis Sesrulebisas bavSvs miewodos martivi ins-truqciebi;

• gakveTilis momzadebis periodi daiyos mcire monakve-Tebad da maT Soris gakeTdes Sesvenebebi;

• axali davalebis micemisas masalas Tan axldes ilustra-ciebi;

• daswavlili masala xSirad gameordes;

• masalis damaxsovrebis gaiolebis mizniT, bavSvs miewo-

��4

dos daswavlis strategiebi;

• ar gamaxvildes yuradReba bavSvis Secdomebze, radgan mudmivi SeniSvnebi aqveiTebs mis TviTSefasebas;

• gamoyenebul iqnas dadebiTi ganmtkiceba davalebis war-matebiT Sesrulebisas;

• davalebis warmatebiT SesrulebisaTvis bavSvs Seeqmnas xelsayreli pirobebi _ masalis gamartiveba, karnaxis sa-fexurebis SemuSaveba da a. S.

travmis saTanado mkurnalobis Semdgom, bavSvis mdgo-mareobis gaTvaliswinebiT, igi, SeiZleba, dabrundes klasSi da CaerTos saerTo saswavlo procesSi; aseve, SesaZlebelia, rom bavSvi klasSi an saxlSi mecadineobdes individualuri programiT.

rogoria qala-tvinis travmis Sedegebis Sefaseba da intervencia?

qala-tvinis travmis dros fsiqologiuri konsultacia gulisxmobs sxvadasxva faqtoris Sefasebas prognozisa da mkurnalobis mizniT. klinikur fsiqologsa da neirofsi-qologs moeTxoveba rogorc bavSvis akademiuri miRwevis, funqciuri SezRudvebisa da qcevis problemebis zogadi prognozi, ise qala-tvinis travmis Sedegebis marTvis pro-gramebis SemuSaveba. neirofsiqologiuri Sefasebisas, ufro xSirad, kompleqsur models iyeneben, romelic farTo spe-qtris cvladebs moicavs. bavSvis Tavis tvinis dazianebisa da kognituri funqciebisa Tu qcevis urTierTmimarTebis gasarkvevad saWiroa sxvadasxva specifikur kiTxvebze pasu-xis gacema. neirofsiqologiuri Sefasebis pirvel, mniSvne-lovan safexurs warmoadgens samedicino informaciis in-terpretacia: samedicino informacia unda amoikribos ava-dmyofobis istoriidan da moicavdes Semdegs:

• dazianebis xasiaTi, neirovizualuri maCveneblebi (kom-piuteruli tomografiis, birTvul-magnitur-rezonan-suli tomografiis monacemebi);

• meoradi garTulebebi, romlebic aRmocendeba intrakra-nialuri hipertenziis, hipoqsiis, iSemiis, tvinis SeSupe-

��5

bis, cerebruli atrofiis, hemoragiisa Tu parkuWebis gafarToebis dros;

• gulyriTi aqtivobisa da Sesabamisi eeg maCveneblebis monacemebi da informacia antikonvulsanturi mkurna-lobis Sesaxeb;

• komis maxasiaTeblebi glazgos komis skalis mixedviT da komis xangrZlivoba;

• travmuli amneziis xangrZlivoba.

yovelive zemoaRniSnuli gaTvaliswinebuli unda iyos fsiqologiuri testebis interpretaciisas.

qala-tvinis travmis dros bavSvis, misi ojaxisa da sko-lis personalis daxmareba moicavs:

• fsiqoganaTlebas, romelic Seicavs informacias bavSvis mdgomareobisa da misi prognozis Sesaxeb;

• periodul samedicino da fsiqologiur Sefasebas dina-mikaSi;

• bavSvisa da mSoblebis konsultacias mexsierebis, emo-ciuri da qceviTi problemebis mogvarebis mizniT. spe-cifikuri prognostuli informacia SesaZlebelia mxo-lod neirofsiqologiuri gamokvlevis safuZvelze.travmis Semdgomi reabilitacia unda xdebodes Semdegi

programebis mixedviT:

• mexsierebis funqciis aRdgenis mizniT: daxsomebis stra-tegiebis aTviseba, garemos struqturireba, sxvadasxva damxmare strategiis gamoyenebis Cvevebis aTviseba, dRis reJimis SemuSaveba.

• metyvelebis funqciebis aRdgenis mizniT: sxvadasxva formis afaziis, dizarTriis Tu metyvelebis sxva problemebis ga-TvaliswinebiT metyvelebis aRdgenis specialuri programe-bi, multisensoruli daswavlis principebis gamoyeneba, sxva-dasxva sensoruli arxebis gamoyeneba kompensaciis mizniT.

• emociuri da qceviTi problemebis daZlevis mizniT: ba-vSvis problemebis gaTvaliswinebiT, qceviTi modifi-kaciis, kognitur-qceviTi an fsiqodinamikuri modelis principebze programebis Seqmna.

��6

hidrocefalia

ra aris hidrocefalia?hidrocefalia anu wyalmanki iseTi paTologiuri mdgo-

mareobaa, rodesac Tavis qalaSi momatebulia Tav-zurg-tvi-nis siTxis (liqvori) raodenoba. axalSobils Tavis qalas subaraqnoidul (rbili garsis) sivrceSi �0-�5 ml siTxe aqvs, xolo zurgis tvinis rbili garsis sivrceSi _ 40-45 ml. hidrocefaliis dros liqvoris raodenoba �-� litra-mde matulobs, mZime SemTxvevaSi ki, SeiZleba, �0 litris odenobasac miaRwios.

hidrocefaliis ra formebi arsebobs?hidrocefalia SeiZleba iyos Tandayolili da SeZenili.

liqvoris mateba ramdenime mizezis gamo xdeba, ris gamoc ganasxvaveben hidrocefaliis sxvadasxva saxes:• hipersekretoruli hidrocefalia _ liqvoris produq-

ciis progresuli zrda;• prezorbciuli hidrocefalia _ liqvoris Sewovis pro-

cesis darRveva.amaT garda ganasxvaveben hidrocefaliis Ria da daxu-

rul formebs:• Ria (SemaerTebeli) wyalmanki xasiaTdeba yvela parkuWis

gafarToebiT, liqvoris momatebiT rogorc parkuWebSi, aseve tvinis subaraqnoidul sivrceSi;

• daxuruli (okluziuri) wyalmanki xasiaTdeba liqvoris mdinarebis moSliT parkuWovani sistemis SigniT, ris ga-moc xdeba liqvoruli sistemis blokireba.Tav-zurg-tvinis siTxis Warbi raodenobiT lokaliza-

ciis mixedviT ganarCeven gareTa da Sida wyalmanks: • gareTa hidrocefaliis dros siTxe subaraqnoidul si-

vrceSi grovdeba;• Sida hidrocefaliis dros siTxis dagroveba xdeba pa-

rkuWebSi.Ria wyalmanki SeiZleba iyos rogorc gareTa, aseve Sida

lokalizaciis. daxuruli wyalmanki ki _ mxolod gareTa lokalizaciisaa.

hidrocefaliis dros farTovdeba tvinis parkuWebi da

��7

Txeldeba tvinis nivTiereba. amasTan, tvinis TeTri nivTie-reba ufro metad ziandeba, vidre ruxi.

mimdinareobis mixedviT ganasxvaveben hidrocefaliis mwvave, qronikul, kompensirebul, subkompensirebul da dekompensirebul formebs.

• kompensirebuli wyalmankis dros misi klinikuri gamo-vlineba ar fiqsirdeba da bavSvi normalurad viTarde-ba;

• subkompensirebuli wyalmankis dros nawilobrivi kom-pensaciis gamo klinikuri niSnebi iolad da zomieradaa gamoxatuli;

• dekompensaciis SemTxveva xasiaTdeba mkveTrad gamoxa-tuli klinikuri niSnebiT da gadaudebel samedicino daxmarebas moiTxovs.

SeZenili hidrocefaliis dros adgili ara aqvs Tavis qa-las moculobis zrdas, an deformacias. amasTan, rac ufro naklebadaa Secvlili Tavis qalas forma da moculoba, miT ufro Zlieria rogorc hipertenziis xarisxi (qalas Sida wneva), ise misi klinikuri simptomebis intensivoba _ Tavis tkivili, gulisreva, Rebineba, Tavbrudaxveva. wyalmankis am formas ar axasiaTebs fsiqikuri ganviTarebis problemebi.

SeZenili wyalmankis formebi Tandayolili wyalmankis formebis msgavsia da am SemTxvevaSic ganasxvaveben wyal-mankis mwvave da qronikul formebs. SeZenili wyalmankis SemTxvevaSi mwvave periodi zogjer ukuganviTarebas gani-cdis, zogjer ki qronikulSi gadadis da stabilur xasiaTs Rebulobs; aseTi SemTxvevebi xSiria qala-tvinis travmis Semdeg.

ra axasiaTebs hidrocefalias?Tanadayolil hidrocefalias axasiaTebs Tavis qalas zo-

mebis zrda da formis Secvla. xSirad, Tavis qalas zoma ukve dabadebis periodisTvisaa gazrdili, rac amZimebs mSobiaro-bis process. aseT dros axalSobilis Tavis qalas garSemo-weriloba 34 sm-is nacvlad 50-70 sm-ia, zogjer ki �00 sm-sac aRwevs. rodesac Tandayolili hidrocefaliis mqone bavSvi Tavis qalas normaluri zomiT ibadeba, xdeba qalas nakere-

��8

bis dacileba da izrdeba yiflibandis zomebi, matulobs qa-lasSida wneva da nevrologiuri simptomebi; icvleba bavSvis Tavis forma: gansakuTrebiT gamoburculi da gafarToebu-lia Sublisa da Txemis midamoebi. Tavis qalas did zomebTan SedarebiT kontrastuladaa gamoxatuli bavSvis patara saxe, romelsac samkuTxedis forma aqvs. sisxlZarRvovani qseli kargadaa gamoxatuli safeTqlis, Sublisa da quTuToebis mi-damoSi. nevrologiuri simptomatikis mravalferovneba da-mokidebulia hidrocefaliis gamovlenis xarisxze.

daxuruli (okluziuri) hidrocefaliisaTvis damaxasia-Tebelia SeteviTi, Zlieri Tavis tkivili, pirRebineba, Ta-vis iZulebiTi mdebareoba, vegetaturi moSlilobebi. wyal-mankis mqone bavSvebi Tavs mogvianebiT iWeren, gvian jdebian, dgebian da iwyeben siaruls. simZimis gamo Tavi Camokiduli aqvT, tani ki moxrili.

hidrocefalia ar niSnavs mxolod Tavis did zomas. zo-gjer Tavis didi moculoba hidrocefaliis gareSe gvxvdeba da ojaxisaTvis damaxasiaTebeli memkvidruli niSania. ami-tom hidrocefaliis arseboba unda dadasturdes klinikuri gamokvlevebiT. iTvleba, rom Tu Tavis garSemoweriloba �0 sm-ze metad ar aRemateba normas, drouli mkurnalobis Se-mTxvevaSi fizikur da fsiqikur ganviTarebaSi bavSvebs pro-blemebi ar eqmnebaT.

zomieri da Zlieri hidrocefaliis arsebobisas bavSvebs aReniSnebaT fsiqikuri ganviTarebis Seneleba an Seferxeba, gviandeba metyvelebis ganviTareba, zog SemTxvevaSi ki vi-Tardeba sxvadasxva xarisxis gonebrivi CamorCeniloba. aseT bavSvebs, rogorc wesi, araCveulebrivi meqanikuri mexsie-reba aqvT. aReniSnebaT arastabiluri emociuri sfero da gamoirCevian maRali STagonebadobiT.

kompensirebuli hidrocefaliis dros bavSvi kargad da uproblemod viTardeba.

ra aris Tandayolili hidrocefaliis mizezi? hidrocefalia, xSirad, mucladyofnis periodSi nayo-

fis sxvadasxva saxis dazianebis mizeziT viTardeba. am mize-zebidan gansakuTrebiT sayuradReboa: orsulobisas dedis infeqciuri daavadebebi: toqsoplazmozi, citomegaloviru-

��9

si, virusuli infeqciebi, romlebic, SeiZleba, ioli forme-biT mimdinareobdes. am paTologiebis fonze xSiria nervu-li lulis ganviTarebis defeqtebi, ris Sedegadac irRveva parkuWovani sistemisa da subaraqnoiduli sivrcis urTier-TkavSiri; zemoaRniSnul paTologiebs gansakuTrebiT mavne zemoqmedebis unari gaaCnia mucladyofnis periodis pirvel trimestrSi, rodesac yvelaze aqtiurad yalibdeba nayo-fis nervuli sistema; Tumca, dedis fexmZimobis meore naxe-varSi gadatanilma daavadebebma, aseve, SeiZleba, gamoiwvios nayofis sxvadasxva saxis darRvevebi. Tandayolili hidro-cefaliis SemTxvevaTa 30%-is mizezia Tavis tvinis silviis wyalsadenis Tandayolili Seviwroeba, 4%-Si ki vlindeba ma-Jandisa da luSkas xvrelebis ganviTarebis defeqtebi.

ra sixSiriT gvxvdeba hidrocefalia?yoveli �000 axalSobilidan �-4-s aReniSneba hidroce-

falia, romelic erTnairi sixSiriT gvxvdeba gogonebsa da biWebSi.

ra aris hidrocefaliis ZiriTadi problema?dekompensirebuli da subkompensirebuli hidrocefa-

liis SemTxvevaSi drouli mkurnaloba unda warimarTos gamomwvevi mizezebis gaTvaliswinebiT. mkurnaloba gansaku-TrebiT aucilebelia progresirebadi hidrocefaliis Se-mTxvevaSi, radgan mkurnalobis gareSe darCenil bavSvs, Sei-Zleba, sicocxlis safrTxe Seeqmnas nevrologiuri simpto-mebis garTulebis, tvinis nivTierebis dazianebis, qalasSida wnevis Zlieri momatebisa da tvinis SeSupebis mizeziT.

zomierad gamoxatuli hidrocefaliis SemTxvevaSi Ziri-Tad problemas warmoadgens bavSvis fsiqikuri ganviTarebis _ metyvelebis, mxedvelobiT-sivrciTi funqciebis, senso-motoruli funqciebis ganviTarebis Seferxeba. hidrocefa-liis mqone bavSvs, SeiZleba, swavlis problemebi hqondes.

SeiZleba Tu ara hidrocefaliis mqone bavSvis daxmareba?

pirvel rigSi, aucilebelia samedicino daxmareba. Semdeg-Si, Tuki bavSvs problemebi aqvs ganviTarebasa da swavlaSi,

�30

saWiroa fsiqologiur-pedagogiuri daxmareba. aucilebe-lia, bavSvis individualuri SesaZleblobebidan gamomdina-re, saswavlo programis SemuSaveba. ufro iol SemTxvevaSi sakmarisia dRis reJimis swori dacva, radgan aseTi bavSvebi swrafad ifitebian; saswavlo moTxovnebis Camoyalibebisas saWiroa bavSvebis SesaZleblobebis gaTvaliswineba.

ikurneba Tu ara hidrocefalia?kompensirebul hidrocefalias ar esaWiroeba mkurnalo-

ba, sakmarisia mxolod perioduli samedicino kontroli.hidrocefalias xarisxisa da formis mixedviT mkurna-

loben medikamentebiT an qirurgiuli wesiT (SuntirebiT).ioli da zomieri hidrocefaliis SemTxvevaSi dadebi-

Ti dinamikisaTvis sakmarisia medikamenturi mkurnaloba da eqimis perioduli kontroli.

mZime hidrocefaliis, an iseTi wyalmankis dros, romel-sac ara aqvs dadebiTi dinamika da mkurnalobis miuxedavad mainc progresirebs, aucilebelia, qirurgiuli operacia da Suntireba. operaciuli Careva gansakuTrebiT warmatebulia hidrocefaliis daxuruli formebis dros, rodesac xdeba parkuWebs an parkuWebsa da subaraqnoidul sivrces Soris arsebuli komunikaciis defeqtis mocileba. wyalmankis Ria formis SemTxvevaSi mizanSewonilia Suntireba _ liqvoris produqciis mudmivi gamotana gareT, specialuri milis sa-SualebiT. drouli operaciis Sedegad liqvoris dinamika regulirdeba da bavSvis Tavis tvins ganviTarebisaTvis normaluri pirobebi eqmneba. miuxedavad imisa, rom opera-ciis Semdeg tvinis nivTierebas dazianeba aRar emuqreba da bavSvi normalurad viTardeba, mas esaWiroeba perioduli samedicino gamokvleva da meTvalyureoba. mkurnalobis Se-degad xdeba an sruli gankurneba, an mdgomareobis stabi-lizacia.

�3�

cerebruli dambla

ra aris cerebruli dambla?cerebruli dambla (cd) im sindromTa jgufia, romle-

bic aRmocendeba bavSvis Tavis tvinis perinataluri (mSo-biarobis periodSi) da postnataluri (dabadebidan pirvel TveebSi) dazianebis Sedegad. igi vlindeba bavSvis motoru-li ganviTarebis _ kunTTa tonusisa da moZraobis koordin-ciis darRvevebiT. cerebruli damblis klinikuri suraTi damokidebulia nayofisa da bavSvis ganviTarebis sxvadasxva periodSi Tavis tvinis dazianebis tipze.

cd-is dros kunTTa tonusi SeiZleba iyos Zalian maRali _ daZabuli, daWimuli (spastika), an Zalian dabali _ mo-Svebuli. kidurebSi, SeiZleba, erTdroulad vlindebodes orive maTgani. kunTTa tonusis meSveobiT adamians SeuZlia sxeuls misces garkveuli mdgomareoba, SeinarCunos sxva-dasxva poza jdomis, dgomis an wolis dros. kunTTa to-nusis swori gadanawileba kidurebisa da tanis sxvadasxva moZraobaSi gvexmareba. mag., imisaTvis, rom xelma moxrisas moqnili da uwyveti moZraoba Seasrulos, unda moxdes zo-gierTi kunTis moduneba, zogis ki _ SekumSva. amasTan, sxva-dasxva kidurebis erTdrouli da SeTanxmebuli moZraobis warmoeba warmoadgens koordinirebul process. cerebruli damblis mqone bavSvebs ar gaaCniaT sakuTari kunTuri to-nusis Secvlis iseTi unari, romelic saWiroa moqnili, Tan-mimdevruli moZraobebis Sesasruleblad da koordinaciac darRveuli aqvT. aseTi bavSvebis moZraobebi mouqneli, uxe-Si da wyvetilia.

moZraobis darRvevebis gamovlinebis mravalferovnebis gamo ganasxvaveben cerebruli damblis sxvadasxva formebs. amasTan, iTvaliswineben gansxvavebuli simptomebis gamoxa-tvis simZimis xarisxsac _ ioli gamovlinebidan Zalze mZime darRvevebamde.

kunTTa tonusis darRvevebis mixedviT gamoyofilia cd-s Semdegi formebi:• spastikuri forma _ kunTTa tonusi Zalze maRalia, kun-

Tebi daWimulia. bavSvs uWirs pozis Secvla, erTi pozi-ciidan meoreSi gadasvla, nebiTi moZraobis Sesruleba.

�3�

maRali tonusi ganapirobebs kontraqturebis warmoqm-nas, zog SemTxvevaSi fexebis gadajvaredinebas, terfis SigniT Setrialebas.

• atonuri-astatiuri forma _ `rbili~ forma, rodesac gamoxatulia kunTTa tonusis Zlieri daqveiTeba, kun-Tebis moduneba. bavSvis sxeuli moSvebulia, uWirs Tavis daWera, didxans jdoma, dgoma, siaruli.

• aTetoiduri forma _ am dros kunTTa tonusi meryeobs sustsa da Zliers Soris, adgili aqvs spazmebs _ daqvei-Tebuli kunTTa tonusis fonze tonusis momatebis Se-tevebs. amis gamo bavSvebs aReniSnebaT kidurebis, saxis kunTebis, kisris uneblie moZraobebi _ hiperkinezebi, romlebsac ver akontroleben. bavSvis nebiTi motoruli aqtivoba garTulebulia, uWirs sxvadasxva pozis miReba da SenarCuneba, elementaruli moqmedebebis Sesruleba.

• naTxemis forma _ kunTTa hiper- an hipotonusTan erTad, xasiaTdeba moZraobis koordinaciisa da wonasworobis darRvevebiT.dazianebuli kidurebisa da klinikuri simptomebis mxa-

reobis mixedviT ganasxvaveben:• spastikur diplegias (litlis sindromi), romelic cd-is

yvelaze xSiri formaa da bavSvis dabadebidan pirvelsa-ve TveebSi vlindeba. axasiaTebs motoruli darRvevebi oTxive kidurSi, metad _ qveda kidurebSi. aqedan gamom-dinareobs misi saxelwodebac: `di~ niSnavs ors, xolo `plegia~ damblas.

• spastikuri hemiplegia _ `hemi~ niSnavs naxevars, `ple-gia~_ damblas. igi xasiaTdeba motoruli darRvevebiT sxeulis romelime mxares, am dros qveda kidurebze me-tad zeda kidurebi ziandeba.

• ormagi hemiplegia _ cerebruli damblis iseTi formaa, rodesac motoruli darRvevebi oTxive kidurSi vlin-deba, magram metadaa gamoxatuli zeda, vidre qveda ki-durebSi.

• tetraplegia _ rodesac Zlieri motoruli darRvevebi oTxive kidurSia gamoxatuli, rac ukiduresad amZimebs bavSvis mdgomareobas.

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riT xasiaTdeba cerebruli dambla?

• cerebruli damblis mqone bavSvebs darRveuli da Sefe-rxebuli aqvT yvela motoruli funqciis Camoyalibeba: Tavis daWera, dgomis, jdomis, siarulis Cvevebi, manipu-laciuri moqmedebebi xelebiT, mxedvelobiT-motoruli koordinacia, artikulacia. daavadebis forma da simZime ganisazRvreba motoruli funqciis ganviTarebis darR-vevis xarisxis mixedviT. cerebruli damblis dros cen-traluri nervuli sistemis dazianebis Sedegad irRveva nebiTi moZraobisaTvis aucilebeli sxvadasxva kunTebis SeTanxmebuli muSaoba, rac iwvevs sxeulis, kidurebis paTologiuri pozebis Camoyalibebasa da dafiqsirebas. yvelaze xSirad gvxvdeba Semdegi araswori pozebi:

�. Tavi aweulia maRla da ukanaa gadaxrili, xelebi da fexebi daWimulia da gaSlili, xerxemali gaSlilia. ase-Ti pozis gamo bavSvebs uWirT zurgze dawolili md-gomareobidan wamojdoma, dgoma, siaruli da xelebiT sagnobrivi moqmedebis warmoeba.

�. Tavi mitrialebulia marjvniv, marjvena xel-fexi gaSli-lia, marcxena – moxrili, an piriqiT. amis gamo, bavSvs ar SeuZlia im xelis moxra, romliskenac Tavia mitria-lebuli da uferxdeba mxedvelobiT-motoruli koordi-naciis (Tvalisa da xelis SeTanxmebuli moZraoba) Camo-yalibeba.

3. Tavi Caqindrulia, xelebi da fexebi _ moxrili. aseTi mdgomareobac xels uSlis dgomis, siarulisa da sagno-brivi moqmedebebis Camoyalibebas.

araswori pozebis gamo bavSvebs uZneldebaT moZrao-bebis Sesruleba da motoruli Cvevebis Camoyalibeba.

• bavSvTa cerebruli damblis dros darRveulia ara mar-to nebiTi moZraobebis Sesruleba, aramed daqveiTebu-lia moZraobaTa SegrZnebac (kinesTetikuri aferenta-cia), ris gamoc sxeulisa da misi nawilebis moZraobis Sesaxeb warmodgenebis Camoyalibebac garTulebulia. amitom aseT bavSvebs xSirad aReniSnebaT taqtiluri aR-qmis deficiti _ bavSvebs uWirT xelis mosinjviT sagne-bisa da maTi maxasiaTeblebis cnoba.

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• araswori pozebis gamo xSiria xelisa da Tvalis SeTanx-mebuli moZraobis darRvevis SemTxvevebi. bavSvs uWirs Tvali miayolos sakuTar, an sxvis moZraobas. es afe-rxebs sagnebis moxmarebis Cvevebis Camoyalibebasa da SemdgomSi saswavlo Cvevebis (kiTxva, wera) aTvisebas.

• cd-is mqone bavSvebi swrafad ifitebian. maT uWirT garkveuli saqmianobis xangrZlivad Sesruleba, an Ta-maSi. daRlis SemTxvevaSi ewyebaT mousvenroba, uneblie moZraobebi.

• aseT bavSvebSi xSiria metyvelebis darRvevebi, rac ga-moixateba bgerebisa da sityvebis gamoTqmis siZneleebSi. saxis, tuCebisa da enis kunTebis tonusis defeqtis gamo maTi moZraoba Zlier SezRudulia. amasTan, bgeraTwar-moqmnis procesis darRvevas maTi araswori sunTqvac aZlierebs. aseTi saxis metyvelebis darRveva, anu dizar-Tria damokidebulia sametyvelo kunTebis kontrolisa da koordinaciis dazianebis xarisxze. bavSvis metyvele-ba SeiZleba iyos neli, Znelad gasarCevi, xma Secvlili, nazaluri elferiT. maTi metyveleba wyvetilia, xmis modulacia _ cvalebadi. cerebruli damblis mqone bav-Svebis �0%-s smenis simaxvile daqveiTebuli aqvs erT, an orive yurSi, rac arTulebs metyvelebis ganviTarebas _ bgerebis sworad gagebas da warmoTqmas. xSiria ylapvis gaZneleba, ReWvis, kbeCis moZraobebis Sesrulebis sir-Tule, Cvilobis periodSi wovis problema, ris gamoc bavSvebi ver Rebuloben sakmaris sakvebs. amitom, aseTi bavSvebis dedebma aucileblad unda icodnen cd-is mqo-ne bavSvis kvebis specifika.

• bavSvebSi, xSirad, mniSvnelovnad ferxdeba mxedvelo-biT-sivrciTi warmodgenebisa da sxeulis sqemis Camo-yalibeba, radganac motoruli funqciebis darRvevis gamo bavSvi araaqtiuria, damoukideblad ver axerxebs sagnebis mosinjvas, pirSi Cadebas, cocvas, xoxvas; uWirs manZilebisa da mxareebis garCeva.

• Tavis tvinis dazianebul ubnebSi neironebis paTolo-giuri aqtivobis gamo cerebruli damblis mqone bavSve-bis �0%-s krunCxviTi gulyrebi aqvs. gulyrebi, SeiZle-ba, sxvadasxva saxis iyos; SedarebiT xSiria generalize-

�35

buli tonur-klonuri krunCxviTi gulyrebi: cnobiere-bis dakargviT, sxeulisa da kidurebis tonuri daWimviT da Semdeg, ritmuli, klonuri gantvirTvebiT. gulyras, SeiZleba Tan axldes uneblie Sardva an, iSviaTad, de-fekacia. generalizebuli krunCxviTi gulyra ramdenime wuTs (3-5) grZeldeba.

ra iwvevs cerebrul damblas?

cerebuli damblis mizezi Tavis tvinis sxvadasxva struq-turis dazianebaa mucladyofnis, mSobiarobis an adreuli axalSobilobis periodSi. amasTan, didi mniSvneloba eniWeba Tavis tvinis dazianebis ganviTarebis asaks. paTologiuri procesi Tavs iCens tvinis Camoyalibebis sxvadasxva stadia-ze da amis Semdgom ferxdeba misi ganviTareba, rac, pirvel rigSi, motoruli funqciebis ganviTarebaze aisaxeba. am Se-mTxvevaSi adgili aqvs Tavis tvinis dazianebis narCen (rezi-dualur) movlenebs, radgan TviT paTologiuri procesis mimdinareoba ukve dasrulebulia.

nayofis Tavis tvinis dazianebis mizezebia:• placentis paTologia;• dedis mier orsulobisas gadatanili infeqcia;• nayofis qronikuli hipoqsia (Jangbadis nakleboba);• orsulis intoqsikacia sxvadasxva qimiuri nivTierebiT

an medikamentiT; • mucladyofnis infeqciebi: citomegalovirusiT, liste-

rioziT, toqsoplazmoziT.mSobiarobis periodSi Tavis tvinis dazianebis faqtori

yvelaze xSirad samSobiaro travmaa. bavSvis tvini, SeiZleba daziandes mZime mSobiarobis, maSebis an vakuum-eqstraqto-ris gamoyenebis, nayofis asfiqsiis, swrafi da naadrevi mSo-biarobis dros.

adreuli axalSobilobis periodSi cerebruli damblis mizezebi, ZiriTadad, infeqciuri xasiaTisaa, iSviaTad _ travmuli etiologiis.

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ra sixSiriT gvxvdeba cerebruli dambla?

sxvadasxva monacemebiT, yoveli �000 axalSobilidan 3-5 bavSvi ibadeba sxvadasxva xarisxis cerebruli dambliT. ma-makacebsa da qalebSi erTnairi sixSiriTaa gavrcelebuli.

ra ZiriTadi problemebia cerebruli damblis dros?

• mTavari problema bavSvis motoruli funqciebis ganvi-Tarebis darRvevaa, rac bavSvis fizikuri da fsiqikuri ganviTarebisaTvis araxelsayrel pirobebs qmnis. Cvi-li garemosa da sagnebs Seicnobs moZraobebiT, sakuTa-ri sxeulis gadaadgilebiT da SegrZnebebiT. ukve oTxi Tvis asakisaTvis mas Tavisuflad SeuZlia Tavis mdgo-mareobis kontroli da sxeuls Tavisuflad abrunebs sivrceSi. 5-6 Tvis asakSi bavSvi jdomas swavlobs, 6-8 Tvis asakSi _ aqtiur cocvas, xolo 8-�� Tvis asakSi fe-xze dgeba da SeuZlia jdomis pozis SenarCuneba. ��-�8 Tvis asakSi siaruls iwyebs da wonasworobis Sesanar-Cuneblad aqtiurad iyenebs xelebs. motoruli aqtivo-bis ganviTarebasTan erTad, bavSvs SesaZlebloba eZleva ufro aqtiurad Seiswavlos garemo _ micocdes, xeli mokidos sagans, pirSi Caidos, mosinjos. imis gamo, rom cerebruli damblis mqone bavSvs Tavis, kisris, zurgis araswori poziciebi aqvs, droulad ver iWers Tavs, ver jdeba, ver icvlis pozas, ver cocavs da ver dgeba da-moukideblad, uWirs sagnebis xelSi daWera da mosinjva, zemoT aRniSnul aqtiurobas moklebulia.

• motoruli funqciis dazianebis xarisxis mixedviT bavS-vebs uWirT TviTmomsaxurebis Cvevebis aTviseba da da-moukideblad ganxorcieleba.

• saskolo asakis problemas warmoadgens damoukidebeli gadaadgileba, ris gamoc gadaadgilebis Sesamsubuqe-blad, saWiroa, garemos Sesaferisi mowyoba. aseT bavS-vebs uWirT fanqrisa da kalmistris xmareba, gakveTil-ze didxans yofna. Tumca, TiToeuli problemis xarisxi damokidebulia daavadebis simZimeze.

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• aReniSnebaT metyvelebis motoruli da artikulator-uli mxaris darRvevebi, rac maT metyvelebas naklebad gasagebsa da usiamovnos xdis.

• imis gamo, rom bavSvs uWirs damoukidebeli moZraoba, pasiuria, ver TamaSobs sxva bavSvebTan da garemo piro-bebis Seusatyvisobis gamo mSoblebs ver dayavT sabavS-vo baRsa da skolaSi, bavSvi izolirebuli rCeba. es ki aferxebs misi socialuri Cvevebis Camoyalibebas da emo-ciuri sferos ganviTarebas.

• bavSvs SeiZleba hqondes emociuri sferos problemebi. cerebruli damblis mqone bavSvebSi xSiria sxvadasxva saxis SiSi, emociuri aramdgradoba, guneba-ganwyobis swrafi cvlileba. amas emateba sakuTari ususurobisa da gariyulobis gancda, rac kidev ufro arTulebs maT emociur mdgomareobas.

• mniSvnelovania cd-is mqone mozrdilis profesiuli orientacia, xolo rTuli motoruli darRvevebis ar-sebobis SemTxvevaSi misi maqsimaluri damoukideblobis miRweva yoveldRiur cxovrebaSi.

rogor unda davexmaroT cerebruli damblis mqone bavSvebs?

• bavSvis daxmareba dabadebis pirvelive Tveebidan iwyeba, rogorc ki gamovlindeba misi motoruli funqciebis deficiti. samedicino daxmareba gulisxmobs medikamen-tur mkurnalobasa da fizikur Terapias _ bavSvis motor-uli funqciis defeqtebis mixedviT SerCeul specialur fizikur savarjiSoebs. fizikuri Terapevti dedas as-wavlis rogor pozaSi kvebos bavSvi, ra gaakeTos misi wovis refleqsis gasaaqtiureblad. fizikuri Terapiis saSualebiT cdiloben bavSvs ar daufiqsirdes sxeulis, Tavis, kidurebis araswori pozebi. aswavlian jdomas, dgomas, siaruls, kibeze asvla-Casvlas, mZime SemTxveva-Si etlis gamoyenebas. iyeneben savarjiSoebis specialur sistemas, romelic bavSvs umsubuqebs kidurebisa da ta-nis daZabulobas, xels uwyobs moZraobaTa koordina-

�38

cias, araswori pozis koregirebas. arsebobs fizikuri Terapiis ramdenime sistema, mag. bobatebis sistema, voi-tas neiroganviTarebis Terapia, raidTerapia, programa MOVE.

• mniSvnelovani daxmarebis gaweva SeuZlia okupaciur Te-rapias, romlis meSveobiTac xdeba yoveldRiuri TviT-momsaxurebisa da sagnebis gamoyenebis Cvevebis aTviseba. adreuli asakidan bavSvebs specialuri savarjiSoebis sistemiT aswavlian sagnebis moxmarebas, Cacmas, Wamas, fanqrisa da makratlis xmarebas, dabanas, kbilebis gax-exvas; sagnebis, ferebis, formebis, teqsturis garCevas. okupaciuri Terapiis mizania bavSvis maqsimaluri sen-somotoruli stimulacia, rac misi fsiqikuri ganviTa-rebisaTvis mniSvnelovan safuZvels warmoadgens.

• metyvelebis problemebis SemTxvevaSi didi daxmarebis gaweva SeuZlia metyvelebis Terapevts (logopeds), ro-melic sametyvelo aparatis gasavarjiSeblad iyenebs specialur masaJebs, savarjiSoebs, aswavlis bavSvs sunTqvis regulacias, axali sityvebis gamoyenebas, wina-dadebis agebas, aumjobesebs misi mosmenis unars.

• cerebruli damblis mqone bavSvebisa da maTi ojaxebi-saTvis aseve mniSvnelovania rekreaciuli Terapia. misi mizania, bavSvis interesebidan gamomdinare, sxvadasxva unarebis ganviTareba da amiT siamovnebis miReba. mo-toruli SesaZleblobebis gaTvaliswinebiT bavSvebs as-wavlian cxenze jdomas (raidTerapia), curvas, xatvas, Zerwvas, xelsaqmes, mcenareebis movlasa da a.S. aseTi Te-rapia, pirvel rigSi, emsaxureba bavSvis rogorc Semec-nebiTi, ise emociuri sferos ganviTarebis xelSewyobas, izolaciis, gariyulobisa da umaqnisobis gancdis Sem-cirebas. bavSvi radikalurad icvleba, rodesac xedavs, rom TviTon SeuZlia iseTi ramis gakeTeba, rasac adre ver axerxebda.

• aseT adamianebs mniSvnelovnad exmareba garemos spe-cialuri dizaini, rac maT uadvilebs damoukidebel saqmianobas. es aris avejis, WurWlis, etlis special-uri dizaini, oTaxebis, kibeebis, tualetis specialuri dagegmareba, rac gansakuTrebiT mniSvnelovania mZime

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motoruli darRvevebis mqone pirebis moqmedebis gasaa-dvileblad. ukanasknel periodSi ganviTarebul qveyneb-Si iqmneba specialuri mowyobilobebi, romlebic Zalian mZime motoruli darRvevebis mqone bavSvebsac ki aZlevs dgomis, jdomisa da siarulis SesaZleblobas.cerebruli damblis mqone pirebisaTvis Zalze efeqtu-

ria sxvadasxva specialistebis erTdrouli, multidiscip-linuri daxmareba, kerZod:

medikamenturi mkurnaloba;metyvelebis Terapia;fizikuri Terapia;okupaciuri Terapia;rekreaciuli Terapia;damxmare teqnikuri saSualebebis gamoyeneba;ojaxis fsiqo-socialuri daxmareba.

gankurnebadia Tu ara cerebruli dambla?

cd qronikuli mdgomareobaa da ar ikurneba. sxvadasxva xarisxis, anu msubuqi, saSualo, an Zlier gamoxatuli moZra-obis problemebi adamians mTeli cxovrebis manZilze aqvs. Tumca, es ar niSnavs imas, rom mkurnalobas azri ara aqvs. cerebrul damblas, rogorc wesi, rac SeiZleba adreuli asakidan da kompleqsurad mkurnaloben. es aris medika-menturi Terapia, specialuri savarjiSoebis sistema (boba-tebis meTodi, voitas meTodi), specialuri savarjiSoebis sistema saTanado teqnikuri uzrunvelyofiT (move), masaJi, raidTerapia (cxenosnoba). TiToeuli Terapiis mizans bavS-vis motoruli sistemis defeqtebis koreqcia warmoadgens.

ra momavali aqvs cerebruli damblis mqone bavSvs?

cerebuli damblis mqone adamianebi, Cveulebriv, da-moukideblobis garkveul xarisxs aRweven, swavloben zo-gadsaganmanaTleblo skolebSi da umaRles saswavleblebSi. damoukidebeli cxovrebis xarisxs gansazRvravs motoruli

•••••••

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darRvevebis simZime. SeiZleba bavSvs swavlis problemebi ar hqondes, magram did problemebs uqmnides skolaSi siaruli, klasSi jdoma, kalmistris xelSi daWera. cerebruli dam-blis saSualo da Zlieri xarisxis mqone pirebisaTvis yve-laze didi problemaa gadaadgileba, rac sazogadoebriv adgilebSi maTi siarulis SesaZleblobas aferxebs.

sxva bavSvebis msgavsad, cerebruli damblis mqone ba-vSvebs gansxvavebuli unarebi da interesebi gaaCniaT. saku-Tari interesebidan da SesaZleblobebidan gamomdinare, mozardobis asakSi, SeiZleba, iseT profesiebs daeuflon, romlebzec mniSvnelovan gavlenas ar moaxdens maTi moto-ruli SezRuduloba.

ganviTarebad qveynebSi aseTi adamianebisTvis profesiis daufleba da swavla mniSvnelovan problemas warmoadgens, radgan, sazogadoebrivi adgilebi maTTvis absoluturad mouwyobelia. gadaadgilebis problemebis mqone adamiane-bisTvis sakmaod rTuli amocanaa quCaSi damoukideblad moZraoba, transportiT sargebloba da maRal sarTulze asvla. sazogadoebrivi adgilebi ki morgebuli ar aris im pirebze, romelTa fizikuri da motoruli SesaZleblobebi SezRudulia. aqedan gamomdinare, aseT qveynebSi, cerebru-li damblis mqone adamiani invalidobisa da izolaciisaTvi-saa ganwiruli, Tundac imitom, rom ara aqvs kargi etli, lifti ar muSaobs, etlisaTvis ar arsebobs specialuri bi-likebi, xolo SenobebSi _ damxmare moajirebi.

im bavSvebisTvis, romelTac gonebrivi ganviTarebis an daswavlis problemebi aqvT, potenciuri unarebis ganviTa-rebis mizniT, aucilebelia maTi fsiqikuri ganviTarebis fsiqologiuri Sefaseba, specialuri programebis SerCeva da ganaTleba individualuri programebis mixedviT.

�4�

epilefsia

ra aris epilefsia?

epilefsia berZnuli sityvidan (epilambanein) warmodgeba da niSnavs ̀ moulodnelobiT Sepyrobils~. aseTi saxelwode-ba daavadebam SeiZina misTvis damaxasiaTebeli simptomis _ krunCxviTi gulyris gamo. epilefsia Tavis tvinis qroniku-li daavadebaa, romelic xasiaTdeba ganmeorebiTi epilef-siuri gulyrebiT. mis biologiur safuZvels Tavis tvinis neironebis paroqsizmuli eleqtruli aqtivobis darRveva warmoadgens, rac klinikurad vlindeba gulyriT (paroq-sizmi), xolo eleqtroencefalografiulad (eeg) _ bioele-qtruli aqtivobis specifikuri paroqsizmuli cvlilebebis saxiT.

epilefsiuri gulyra epilefsiis aucilebeli kliniku-ri niSania. gulyrebi mravalferovania da SeiZleba hqondes krunCxvis, cnobierebis Secvlis, fsiqomotoruli agznebis, mgrZnobelobis, emociuri da vegetatiuri funqciebis moS-lilobis saxe. paTologiuri neironuli aqtivobis ubnis, anu epilefsiuri keris lokalizaciisa da am ubnidan paTo-logiuri aqtivobis sxva struqturebSi gavrcelebis mixed-viT, epilefsiur gulyraTa saerTaSoriso klasifikaciaSi (�98�) gamoyofilia gulyraTa ori ZiriTadi tipi: • lokalizaciadamokidebuli, anu kerovani (fokaluri,

parcialuri);• generalizebuli.

epilefsiuri sindromi. gulyraTaSoris periodSi epi-lefsia, SesaZloa, sruliad usimptomod mimdinareobdes an mravalferovani klinikuri da eleqtroencefalografiuli fenomeniT anu simptomiT xasiaTdebodes. am simptomebis, gulyraTa tipebis, epilefsiis etiologiuri faqtorebis, daavadebis manifestaciis asakisa da mimdinareobis Tavise-burebebis sxvadasxva kombinacia qmnis met-naklebad stereo-tipul eleqtroklinikur epilefsiur sindromebs.

epilefsia polietiologiuri daavadebaa, amitom igi, SeiZleba iyos Tavis tvinis nebismieri struqturuli Tu metaboluri daavadebis wamyvani an Tanmxlebi simptomi.

�4�

etiologiuri faqtorebis mixedviT gamoyofen epilef-siebis sam ZiriTad jgufs:• simptomurs _ rodesac epilefsiis gamomwvev mizezs cen-

traluri nervuli sistemis sxvadasxva saxis dazianeba warmoadgens (Tavis tvinis struqturuli dazianebebi, metaboluri darRvevebi, sisxlZarRvovani paTologie-bi);

• kriptogenurs _ rodesac klinikuri suraTiT epilefsia simptomuria, magram dazianebis dadastureba ver xerx-deba neirovizualuri gamokvlevebiT;

• idiopaTiurs _ rodesac daavadebis etiologiuri faq-tori ucnobia. epilefsiis manifestaciis asakis mixedviT gamoyofen

asakdamokidebul formebs: CvilTa, iuveniluri, mozrdilo-bis, xanSiSesulTa;

daavadebis mimdinareobis mixedviT ganarCeven: keTilT-visebian da avTvisebian, progresulad mimdinare, epilef-siebs.

erTjeradi gulyra ar niSnavs epilefsias, rogorc daa-vadebas. garkveul pirobebSi an garemos mavne zemoqmedebi-sas organizmis reaqcia, xSirad, epilefsiuri gulyriT vlindeba. es aris centraluri nervuli sistemis pasuxi gare, mavne gamRizianebelze anu epilefsiuri reaqcia, ro-melic erTeul xasiaTs atarebs. aseT reaqcias, SeiZleba, ad-gili hqondes mwvave mowamvlis, alkoholuri intoqsikaciis, maRali sicxis dros. bavSvebSi aseTi gulyrebis gavrcele-buli magaliTebia _ febriluri gulyrebi, mozrdilebSi _ alkoholuri abstinenciis krunCxviTi Setevebi, orsulebSi _ eklamfsia.

paroqsizmuli gantvirTvis unari neironebis zogadbi-ologiuri Tvisebaa, amitom epilefsiuri reaqciis, anu gu-lyris gamowveva nebismier janmrTel adamianSia SesaZlebe-li (magaliTad, eleqtruli an insulinuri SokiT). magram sinamdvileSi, aseTi gulyra mosaxleobis mxolod 5%-s aqvs gancdili. es faqti imis mauwyebelia, rom krunCxvebi-sadmi ganwyoba, anu mzaoba, individuria da damokidebulia ara marto tvinis morfologiuri Tu funqciuri ganviTa-rebis safexurze, aramed mraval Sinagan (endogenur) da

�43

garegan (egzogenur) faqtorze. amis gamo krunCxvebisadmi midrekilebis xarisxi yvela adamianSi gansxvavebuli da in-dividuria. krunCxviTi fenomenebi gansakuTrebiT xSiria bavSvebSi, radgan maT Tavis tvins axasiaTebs: agznebis da-bali zRurbli, mTels tvinSi agznebiTi procesis swrafi gavrcelebisaken midrekileba, SekavebiTi procesebis uk-marisoba, Jangbadis Warbi moTxovnileba da a.S. yvela CamoT-vlili mizezi gulyris ganviTarebis maprovocirebel faq-tors warmoadgens.

xSirad krunCxviTi mzaoba vlindeba mxolod eeg cvli-lebebiT. aseT SemTxvevebSi gulyris realizacias, SeiZle-ba, xeli Seuwyos organizmis Sinagani wonasworobis mcire-odenma meryeobam, rogoricaa magaliTad, uZiloba, fsiqi-kuri stresi, fizikuri gadaRla, klimaqteruli periodi, menstruacia, orsuloba.

epilefsiis paTofiziologiur jaWvze mniSvnelovan gavlenas axdens genetikuri faqtorebi, romelTa rolic yvelaze mniSvnelovania idiopaTiuri epilefsiebis ganvi-Tarebis SemTxvevebSi. meore mxriv, epilefsia ar aris mem-kvidruli daavadeba am sityvis viwro gagebiT, radgan STa-momavlobaSi epilefsiis ganviTarebis risks gansazRvravs probandis epilefsiuri sindromis tipi. amasTan, memkvi-dreobiT xdeba ara rogorc daavadebis _ epilefsiis ga-dacema, aramed krunCxviTi aqtivobis dabali zRurblisa anu gulyrebisadmi winaswarganwyobis (predispozicia). ma-gram mxolod es predispozicia araa sakmarisi epilefsiuri daavadebis ganviTarebisaTvis, radgan daavadebis realiza-ciisTvis aucilebelia, damatebiT Tundac erTi romelime gareSe mavne faqtoris Tanxvedrac.

ra axasiaTebs epilefsias?

epilefsia sxvadasxva tipis gulyrebiT mimdinareobs. zogjer gulyra paroqsizmuli motoruli an sxvadasxva Seg-rZnebebiTa da maTi kombinaciebiT gamovlindeba; zogjer ki _ uxilavia da mxolod eeg-ze aisaxeba. gulyris qceviTi da subieqturi gamovlinebebisa da eeg maxasiaTeblebis kombi-

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naciaTa safuZvelze epilefsiasTan mebrZoli saerTaSoriso ligis (ILAE) mier �98� wels mowodebul iqna epilefsiur gulyraTa klasifikacia, romlis mixedviTac gamoyofilia gulyraTa Semdegi tipebi:

�. parcialuri (fokaluri, kerovani, lokalizebuli) gulyrebi A. martivi parcialuri gulyrebi:�. motoruli simptomebiT:

• fokaluri motoruli marSis gareSe;• fokaluri motoruli marSiT (jeqsonis marSi);• versiuli;• posturuli;• fonatoruli (vokalizacia an metyvelebis SeCereba).

2. somatomotoruli an specifikuri sensoruli simptom-ebiT:

• somatosensoruli;• vizualuri (mxedvelobiTi);• auditoruli (smeniTi);• olfaqtoruli (ynosviTi);• gustatoruli (gemovnebiTi);• TavbrudaxveviT.

3. avtonomiuri simptomebiT: SegrZnebebi muclis RruSi, sifermkrTale, oflisdena,

wamowiTleba, nerwyvdena, gugebis gafarToeba _ dilata-cia.4. fsiqikuri simptomebiT (umaRlesi qerquli funqciebis darRveva):

• disfaziuri;• dismneziuri (mag.: deJa-vu);• kognituri (mag.: sizmrismagvari mdgomareoba, drois

SegrZnebis darRveva);• afeqturi (SiSi, brazi da sxv.);• iluzoruli (mag.: mikrofsia, makrofsia);• struqturuli halucinaciebi (mag.: musika, scenebi);

es simptomebi iSviaTad aRmocendeba cnobierebis Secv-lis gareSe da xSirad gvxvdeba rTuli parcialuri Seteve-bis dros.

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B. rTuli parcialuri gulyrebi:1. martivi parcialuri, momdevno cnobierebis SecvliT:

• martivi parcialuri gulyrebi (A1-A4) momdevno cnobierebis SecvliT;

• avtomatizmebiT.2. dasawyisidanve cnobierebis SecvliT:

• mxolod cnobierebis SecvliT;• avtomatizmebiT.

C. parcialuri gulyra meoreuli generalizaciiT: (generalizebuli gulyra SeiZleba iyos tonur-klonuri, klonuri an tonuri)1. martivi parcialuri gulyra (A) meoreuli generaliza-

ciiT;2. rTuli parcialuri gulyra (B) meoreuli generaliza-

ciiT;3. martivi parcialuri gulyra (A) rTulSi gardamavali (B)

generalizaciiT.

2. generalizebuli gulyrebi (arakrunCxviTi da krunCxviTi)A. absansebi1. tipiuri absansebi (Petit mal):

• mxolod cnobierebis SecvliT;• susti klonuri komponentiT;• atonuri komponentiT;• tonuri komponentiT;• avtomatizmiT;• avtonomiuri komponentiT.

2. atipuri absansebi:• tonusis meti cvlilebiT, vidre A1;• TandaTanobiTi dawyebiT da/an damTavrebiT.

B. mioklonuri gulyrebi;C. klonuri gulyrebi;D. tonuri gulyrebi;E. tonur-klonuri gulyrebi (Grand mal);F. atonuri gulyrebi (astaturi gulyrebi).

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3. araklasificirebadi epilefsiuri gulyrebi:moicavs iseT Setevebs, romelTa klasifikacia SeuZle-

belia monacemebis ukmarisobis gamo, an maTi klasificire-bis SeuZleblobis mizeziT.

4. epilefsiuri statusi.

generalizebuli tonur-klonuri krunCxva (Grand mal) _ zogadi cnebaa yvela pirveladad da meoreulad gene-ralizebuli tonuri, klonuri, an yvelaze xSirad, tonur-klonuri krunCxviTi gulyrebisTvis. aseTi tipis Seteva, romelic gonebis uecari dakargviT iwyeba, epilefsiis yve-laze dramatuli gamovlinebaa. zogjer, generalizebuli tonur-klonuri krunCxva viTardeba Senaxuli cnobierebis fonze winaswari SegrZnebebis, cnobierebis xanmokle Secvli-sa da araadekvaturi qmedebebis Semdeg. aseT SemTxvevaSi Se-tevebi yvelaze xSirad interpretirdeba, rogorc parcia-luri Seteva meoreuli generalizaciiT. generalizebuli tonur-klonuri gulyra sami fazisagan Sedgeba: pirvel fazaSi adamiani yovelTvis kargavs cnobierebas, vardeba, ewyeba sxeulisa da kidurebis daWimuloba (tonuri faza); am dros sxeulis yoveli kunTi daWimulia, adamiani, TiTqos, izmoreba. sunTqvis gaZnelebis gamo saxe jer fermkrTali aqvs, Semdeg molurjo-mowiTalo elferis. Tavi da Tvalebi zogjer erT-erT mxares, an zemoTaa miqceuli. pirveli faza daaxloebiT � wuTamde grZeldeba da gulyra Tanda-TanobiT gadadis meore _ klonur fazaSi. am dros adamiani iwyebs Tavisa da kidurebis moxra-gaSliTi xasiaTis rit-mul moZraobebs, xmauriTa da uwesrigod sunTqvas, xroti-nebs, saxeze TandaTan ubrundeba Cveuli feri, zogjer pi-ridan gadmoedineba sisxlnarevi duJi (enis mokvnetis gamo). sxeuli uxvi ofliT ifareba, icvleba sxeulis temperatura _ imatebs, an klebulobs. am dros xSiria uneblie Sardva, defekacia. gulyris Semdeg bavSvebSi xSiria pirRebinebac. mTliani gulyra maqsimum 5 wuTamde grZeldeba, Tumca, ba-vSvebSi, SeiZleba, ufro xangrZlivic iyos _ �0 wuTi. misi damTavrebis Semdeg iwyeba mesame _ postiqtaluri faza da am fazaSi adamiani, umravles SemTxvevaSi, iZinebs. rac ufro

�47

mcire asakisaa bavSvi, miT ufro xanmokle da Rrma ZiliT sZinavs. gamoRviZebis Semdeg mas araferi axsovs, gabruebu-lia, daRlili, SeiZleba hqondes Tavis tkivili. xandaxan, gulyris Semdeg, uWirT metyveleba, TiTqos ar hyofniT si-tyvebi. krunCxviTi gulyra, SeiZleba, ganviTardes rogorc sifxizleSi, aseve ZilSi, gansakuTrebiT CaZinebis an gamoR-viZebis momentSi.

gulyras, xSir SemTxvevaSi, win uZRvis sxvadasxva Se-grZnebebi da fsiqikuri mdgomareoba. zogierT adamians gulyris ganviTarebmde ramdenime saaTiT adre ewyeba Tavis tkivili, an umZimdeba Tavi Tu kidurebi, uqveiTdeba guneba-ganwyoba, xdeba uxaliso; SeiZleba, hqondes usiamovno Segr-Znebebi muclis areSi, guliscemis aCqareba, simxurvalis, an sicivis SegrZneba da a.S.

pirveladad generalizebuli gulyrebi:pirveladad generalizebuli krunCxviTi gulyra. es

gulyra zemoaRwerili tonur-klonuri krunCxviTi gulyris msgavsia, magram igi yovelgvari winaswari SegrZnebis gareSe viTardeba da adamiani uecrad, mowyvetiT vardeba.

generalizebuli krunCxviTi gulyrebis garda, arsebobs sxva mravalnairi tipis epilefsiuri Setevac, romlebsac arakrunCxviTi gulyrebis kategorias miakuTvneben.

arakrunCxviTi generalizebuli gulyrebi: absansi (Petit mal) _ iyofa martiv da rTul tipebad.• martivi absansi xasiaTdeba cnobierebisa Tu reaqtiu-

lobis xanmokle (sul ramdenime wami), uecari SecvliT an dakargviT. bavSvi uecrad wyvets moqmedebas, irin-deba; imave pozaSi rCeba, romelSic gulyram mouswro. SekiTxvaze ar pasuxobs; Setevisas, SeiZleba, ganviTar-des Tvalis kaklebis wamieri miqceva zeviT, rasac kli-nikuri terminologiiT `uazro mzeras~ uwodeben, xolo mSoblebi `Tvalebis gaSterebis~ saxeliT moixseneben. ramdenime wamis Semdeg bavSvi agrZelebs moqmedebas da ar axsovs, rom ugonod iyo. martivi anu tipuri absan-sebi, SeiZleba, Tanxlebuli iyos mcire motoruli simp-tomatikiT, mag.: Tvalebis xamxamiT. absansebi damaxasia-

�48

Tebelia 5-dan �5 wlamde asakis bavSvebisTvis. mSoblebi da maswavleblebi, xSirad, ver amCneven aseT Setevebs; am mdgomareobis gamo garSemomyofebi bavSvebs aRiqva-men rogorc uyuradRebo, dabneul pirebad. xSirad, Tveebis an wlebis ganmavlobaSi absansebis arsebobis garkveva xerxdeba mxolod generalizebuli krunCxviTi gulyris ganviTarebis mizeziT eqimTan moxvedrisas, de-taluri gasaubrebis safuZvelze. tipiur absanss axasi-aTebs specifikuri eeg-korelanti _ 3 pik-talRa wamSi.

• atipuri absansi _ aseTi tipis Seteva aris tipiuri ab-sansi, romelsac Setevis dawyebisTanave, an odnav mogvi-anebiT, Tan erTvis qvemoT CamoTvlili erTi an ramden-ime fenomeni:_ miokloniebi Cveulebriv, quTuToebis xamxami, kunT-

Ta tonusis sxvadasxva xarisxis Znelad SesamCnevi an gamoxatuli Secvla,

_ avtomatizmebi, gansakuTrebiT Setevis 30 wamze meti xangrZlivobis dros,

_ sxvadasxva vegetatiuri simptomi.atipuri absansis eeg-korelantebi tipiuri absansis eeg-

maCveneblebisagan gansxvavebulia.

arakrunCxviTi parcialuri gulyrebi:parcialuri (fokaluri) gulyrebi epilefsiuri Setevebis

meore did jgufs Seadgens. aseTi gulyrebis dros paTolo-giuri aqtivoba lokalizebulia Tavis tvinis mxolod erT ubanSi an vrceldeba paTologiuri keris mezoblad mdebare sxva ubnebzec. aseTi gulyrebi, ZiriTadad, zrdasruli ada-mianebisTvisaa damaxasiaTebeli da SedarebiT iSviaTia bavS-vebSi. gulyris procesSi cnobierebis donis mixedviT ga-nasxvaveben martiv da rTul parcialur gulyrebs. • martivi parcialuri gulyrebis dros cnobiereba naTe-

lia. amis magaliTia jeqsonis, e.w. fokaluri motoruli gulyra, rodesac naTeli cnobierebis fonze adamians sxeulis, an kiduris romelime nawilSi uecrad ewyeba kunTebis ritmuli gantvirTvebi. Setevas, SeiZleba, win uswrebdes daWimulobac. Semdeg krunCxvebi SeiZleba gavrceldes mTel kidurze da sxeulis sxva nawilebzec.

�49

magaliTad, fokaluri klonuri krunCxva SeiZleba dai-wyos xelis mtevnidan da gavrceldes mxarze, gadavides saxeze, an fexze. Seteva wydeba krunCxvebis ganviTarebis sapirispiro TanmimdevrobiT.arsebobs sxva tipis motoruli gulyrebic, mag. adversi-

uli gulyra, romelic, SeiZleba, mxolod Tavisa da Tvalis kaklebis mitrialebiT an sxeulis mobrunebiT gamovlindes. Tumca, zogjer igi gadadis generalizebul gulyraSi.

tonur-posturaluri gulyris dros Seteva iwyeba yvela kunTis daWimviT, rasac, SeiZleba, mohyves maTi TrTolva da adamianma miiRos raime uCveulo poza. aseTi tipis Setevebi xSiria bavSvebSi.

martiv parcialur gulyrebs ganekuTvneba vegetatur-visceraluri gulyrebic, rodesac naTeli cnobierebis fonze aRiniSneba SeteviTi xasiaTis tkivilebi gulis areSi, diskomforti muclis areSi da Sardis buStSi, wyurvilis, SimSilis SegrZneba, Termoregulaciis, sunTqvis, gulis ritmis darRveva, oflianoba.

mgrZnobelobiTi gulyrebi moicavs somatosensorul, mxedvelobiT, smeniT, ynosviT, vestibularul Setevebs. so-matosensoruli Setevisas adamians kidurebsa da sxeulSi aqvs Cxvletis, dabuJebis, `WianWvelebis cocvis~ SegrZneba, zogjer tkivilis SegrZneba. es Seteva SeiZleba gavrceldes da Sewydes jeqsonis tipis gulyris msgavsad.

mxedvelobiTi, smeniTi, ynosviTi da sxva saxis sensoru-li gulyrebi, xSirad, didi gulyris winamorbedi niSnebia; am SemTxvevaSi maT auras uwodeben, rac berZnulad `niavis qrolas~ niSnavs. `aura~ moZvelebuli terminia da amitom gulyraTa klasifikaciaSi ar aris gamoyofili. auras tipi damokidebulia Tavis tvinis im ubanze, saidanac iwyeba gu-lyra. igi, SeiZleba, win uswrebdes Setevas, an, SeiZleba, Seteva auriT dasruldes. amitom, dReisaTvis, aura ganix-ileba, rogorc gulyris sawyisi an bolo faza, anu gulyris erT-erTi komponenti. igi SeiZleba iyos sensoruli (Cxv-letis, sinaTlis, sunis, gemos, xmauris SegrZnebebis saxiT), motoruli (stereotipuli moZraobebi, cemineba, xveleba, mTqnareba), vegetatiur-visceraluri (gulisreva, slokini, usiamovno SegrZnebebi gulisa da muclis areSi), fsiqikuri

�50

(SiSis, saSinelebis an piriqiT, sixarulis gancda, aRqmis iluziebi _ damaxinjebuli aRqma, drois SegrZnebis dar-Rveva, smeniTi da mxedvelobiTi halucinaciebi).

rTuli parcialuri gulyra cnobierebis SecvliT mimdi-nare Setevaa. aseTi gulyrebi epilefsiuri Setevebis erT-erTi yvelaze gavrcelebuli tipia. rTuli parcialuri gulyris dros cnobierebis Secvlas, zogjer win uswrebs martivi parcialuri gulyra, zogjer ki is pirdapir cno-bierebis SecvliT iwyeba. adamians araviTari ucnauroba ar etyoba, TiTqos gonebas ar kargavs, arc halucinaciebi da iluziebi ar aReniSneba, agrZelebs Tavis saqmianobas, Tum-ca, mis moqmedebas avtomaturi xasiaTi aqvs. gulyris Sem-deg am momentis Sesaxeb araferi ar axsovs. zogjer TviT gulyris arsebobasac uaryofs. xSirad, dabinduli cno-bierebis miuxedavad, agrZelebs ra mimdinare moqmedebas, iwyebs axali tipis qmedebebsac: ZebniTi an mosinjvis moZ-raobebi; ReWviTi, cmacunis, ylapviTi moZraobebi; SeiZleba iyviros, itiros, imReros, iCxubos. Setevis Semdeg ki aRniS-nulis Sesaxeb araferi ar axsovdes. aseT qmedebebs avtoma-tizmebs uwodeben. dabinduli cnobiereba adamians SeiZleba ramdenime wams hqondes, an didxans gagrZeldes, ramdenime saaTs, Tundac, mTel dRes. am dros adamiani avtomaturad moqmedebs da garegnulad Zneli gasarCevia, cnobiereba na-Teli aqvs Tu ara.

epilefsiuri statusi _ zedmiwevniT gaxangrZlivebuli (30 wuTze meti) epilefsiuri gulyra an mijriT mimdinare epilefsiuri gulyrebi, romelTa Soris intervalebSi pa-Tologiuri simptomatikis ukuganviTareba ver eswreba. epilefsiuri statusi, SesaZloa, nebismieri saxis gulyriT gamovlindes, amitom statusi unda ganisazRvros gulyris formis mixedviT: absans- statusi, krunCxviT gulyraTa statusi, parcialur gulyraTa statusi da a.S. epilefsi-uri statusebidan yvelaze xSiria generalizebul tonur-klonur krunCxviT gulyraTa statusi. yvela SemTxvevaSi saWiroa gadaudebeli samedicino daxmareba.

epilefsiur gulyraTa seria _ statusisagan gansxvavebiT, iseTi paTologiuri mdgomareobaa, rodesac erTi gulyris damTavrebidan mcire intervalis Semdeg iwyeba meore, mesame

�5�

da a.S., magram gulyrebs Soris intervalebSi paTologiuri simptomebi ar vlindeba. epilefsiur gulyraTa seriis Sem-TxvevaSic, aucilebelia gadaudebeli samedicino daxmareba, raTa ar gadaizrdos epilefsiur statusSi.

bavSvebsa da mozrdilebSi epilefsiis mimdinareoba gan-sxvavebulia. krunCxviTi reaqciebisadmi midrekileba bavS-vebSi metadaa gamoxatuli, vidre mozrdilebSi. bavSvebSi ufro xSirad gvxvdeba gulyrebi ucabedi vardniT ukan, an win, mozrdlebTan SedarebiT, generalizebuli gulyrebic �-jer xSiria.

axalSobilobis periodis bavSvebSi gulyrebi sakmaod xanmoklea da Znelad SesamCnevi, radgan isini Zalian hgavs am asakis bavSvis fiziologiur qcevebs. magaliTad, gulyra SeiZleba gamovlindes mzeris xanmokle fiqsaciiT, gugebis moZraobiT, mTqnarebiT, gazmorebiT, sifermkrTaliT da a.S. Cvil bavSvebSi iSviaTia pirze duJi, uneblie Sardva da defekacia. SedarebiT SesamCnevia xanmokle (erT wuTamde) tonuri gulyrebi, romlebic erT wlamde asakis bavSvebSi epilefsiuri gulyrebidan yvelaze xSirad gvxvdeba. aseTi gulyrebi am asakSi xasiaTdeba upiratesad ormxrivi, sime-triuli, magram arasruli fazebis mqone SetevebiT. sami wlis asakidan tonuri gulyra ukve tonur-klonur krunCx-vaSi gadaizrdeba.

bavSvTa asakis epilefsiuri sindromebia mag.: vestis sindromi (infantiluri spazmi), lenoqs-gastos sindromi, draves sindromi, progresuli mioklonuri epilefsia; pre-pubertatis asakSi yvelaze xSiria bavSvTa asakis absans-epilefsia, piknolefsia (fridmanis sindromi); pubertatis asakis bavSvebSi yvelaze xSirad gvxvdeba iuveniluri ab-sans-epilefsia, iuveniluri mioklonuri epilefsia (iancis sindromi), fotosensitiuri refleqs-epilefsia.

vestis sindromi, anu infantiluri spazmi vlindeba 3-dan �� Tvemde asakis bavSvebSi. Seteva gamoixateba Tavis uecari CaqindvriT, tanisa da kidurebis uecari moxriTi an gaSliTi moZraobebiT; gulyrebs axasiaTebs ganmeorebadi da seriuli mimdinareoba. amgvari Setevebi `salaamis~ tipis gulyrebis saxeliTaa cnobili. aseT SemTxvevebSi bavSvis fsiqikuri ganviTareba Zlier CamorCeba asakobriv normas

�5�

da progresirebad xasiaTs atarebs,. lenoqs-gastos sindromi bavSvTa asakis tvinis difuzuri

an mravalkerovani dazianebis safuZvelze ganviTarebuli erT-erTi umZimesi mimdinareobis epilefsiuri sindromia. xasiaTdeba mravalferovani klinikuri gulyrebiT. yvelaze xSiria tonuri, atonuri (dRis ganmavlobaSi bavSvi xSirad uecrad vardeba), mioklonuri gulyrebi, atonuri absansebi. am daavadebis dros xSiria absans-statusi da tonur guly-raTa statusi. lenoqs-gastos sindroms xSirad win uZRvis epilefsia infantiluri spazmebiT (uestis sindromi). daa-vadebis erT-erTi ZiriTadi maxasiaTebelia fsiqikuri ganvi-Tarebis Zlieri CamorCena, rac xSirad win uZRvis gulyrebis gaCenas (lenoqs-gastos sindromis meoreuli forma) an vi-Tardeba gulyrebis manifestaciis Semdeg (sindromis pirve-ladi forma). gulyrebi Zalze Znelad eqvemdebareba anti-epilefsiur mkurnalobas. aseT bavSvebSi mniSvnelovnadaa gazrdili travmatizmis riski, amitom aucilebelia bavSvis dacva travmuli dazianebebisagan specialuri rbili iat-akisa da Tavis specialuri Cafxutis meSveobiT.

piknolefsia viTardeba 4-�0 wlis bavSvebSi. maT aReniS-nebaT xSiri tipiuri (martivi) absansebi (ix. zemoT). zogjer, Setevebi mimdinareobs cnobierebis xanmokle gaTiSviT, Tva-lis kaklebis, Tavisa da tanis moZraobiT ukan. aseTi bavSve-bi advilad agznebadni da emociurad arastabilurni arian. epilefsiis am formis dros bavSvis gonebrivi ganviTareba normis farglebSia.

iuveniluri mioklonuri epilefsia _ iancis sindromi gvxvdeba �0-��-dan �8 wlamde asakis mozardebSi. igi war-moadgens idiopaTiur, generalizebul, asakTan dakavSire-bul epilefsias, romelic xasiaTdeba TiTqmis yoveldRi-uri erTeuli an seriuli, ormxrivi, Cveulebriv, sinqro-nuli (iSviaTad asinqronuli) miokloniebiT _ ama Tu im kunTTa jgufebis uecari SekrTomiT. ritmuli biZgebi, gan-sakuTrebiT xSirad vlindeba saxis, zeda da qveda kidurebis kunTebSi. Setevebi xSiria gaRviZebisas, CaZinebisas an Zil-Si.

fotosensitiuri refleqs-epilefsiis dros gulyra provocirdeba sinaTliT Zlieri gaRizianebis fonze, Suq-

�53

Crdilis ritmuli monacvleobiT, sinaTlis cimcimiT. bavS-vs epilefsiuri gantirTva uviTardeba absansis, quTuToe-bis xamxamis saxiT, iSviaTad axlavs didi gulyra. am dros, mizanSewonilia, mwvane feris SuSis saTvalis xmareba. aseTi gulyra xSirad provocirdeba televizoris cqerisas. mci-re, iSviaTad ki didi gulyrebi SeiZleba ganviTardes ekran-ze swrafad mocimcime gamosaxulebis yurebisas.

eqvsi Tvidan xuT wlamde asakis bavSvebs, virusuli in-feqciebiT gamowveuli maRali temperaturis fonze, xSirad uviTardebaT krunCxviTi gulyrebi, Tumca, SesaZloa, gu-lyra aRmocendes temperaturis swrafi daqveiTebis pro-cesSic. aseT Setevebs febrilur gulyrebs uwodeben. isini iSviaTia xuTi wlis Semdeg.

bavSvebSi krunCxviTi gantvirTvebi yovelTvis ar fasde-ba epilefsiur gulyrebad. krunCxvebi SeiZleba ganviTardes kalciumis naklebobis _ hipokalcemiis dros, Saqris do-nis daqveiTebisas, anu hipoglikemiis dros. bavSvebSi xSi-ria gulis wasvlebi Jangbadis ukmarisobis, gadaWarbebuli moZraobebis, emociuri daZabulobis dros, bavSvs ucivdeba xel-fexi, exveva Tavbru, aqvs yurebSi Suili, oflianoba, gulisreva, kunTebis moduneba, an is uecrad ecema, kar-gavs gonebas, fermkrTalia. zogjer aReniSneba kunTTa daWimuloba _ tonuri spazmi. aseTi Setevebi garegnulad, SeiZleba, hgavdes epilefsiur Setevas, magram sinamdvile-Si, isini araepilefsiuri Setevebis jgufs miekuTvneba. am dros saWiroa mxolod bavSvis horizontalur mdgomareo-baSi gadayvana, rac misi mdgomareobis swraf normalizacias iwvevs.

afeqtur-respiratoruli paroqsizmi _ viTardeba xmama-Rali, gabmuli tirilis, an Zlieri uaryofiTi emociis dros, rodesac bavSvs sunTqva ekvris, ZiriTadad, CasunTqvisas, ulurjdeba saxe, tuCebi, tirilis dros bJirdeba. aseTi Setevebi araepilefsiuri gulyrebia, romlebic aReniSneba emociurad arastabilur, advilad agznebad bavSvebs. Tumca, aseTi Seteva, SeiZleba, gadavides generalizebul gulyraSi, rac imis maniSnebelia, rom bavSvs genetikurad ganpirobe-buli dabali krunCxviTi agznebadobis zRurbli aqvs.

�54

ra mizezi iwvevs epilefsias?

epilefsia viTardeba Tavis tvinis nervuli ujredebis agzneba-Sekavebis meqanizmebis darRvevis Sedegad. epilef-sia polietiologiuri daavadebaa, anu mas mravali sxvadasx-va mizezi SeiZleba iwvevdes, ris Sedegadac icvleba tvinis neironebis aqtivoba.

bavSvebSi epilefsiis mizezi SeiZleba iyos: prenataluri (mucladyofnis periodis) faqtorebi: dedis infeqciuri daavadeba, nayofis qronikuli hipoqsia, intoqsikacia, alko-holisa da medikamentebis miReba. perinataluri faqtore-bidan yuradsaRebia: asfiqsia _ Jangbadis nakleboba, Tavis tvinis samSobiaro travmebi (maSebis, vakuum-eqstraqtoris gamoyeneba); postnataluri faqtorebidan: neiroinfeqciebi, tvinis garsebis anTeba (meningiti) an tvinis nivTierebis an-Teba (encefaliti), qala-tvinis travmebi. yovelive es aris egzogenuri faqtorebi, romlebic SeiZleba gaxdes Tavis tvinis neironebis paTologiuri aqtivobis mizezi da xeli Seuwyos epilefsiis ganviTarebas.

zemoT ukve xazgasmuli iyo, rom daavadebis ganviTare-baSi mniSvnelovani faqtoria memkvidreobiT ganpirobebuli nervuli ujredis metaboluri Taviseburebebi, rac qmnis gu-lyriTi mzaobis winaswar ganwyobas da amcirebs Tavis tvinis gulyriTi aqtivobis zRurbls. memkvidreobiTi faqtoris mniSvneloba dasturdeba tyupebisa da epilefsiiT daavade-bulTa ojaxebis gamokvlevebiT. idiopaTiuri epilefsiiT daavadebulTa SvilebisaTvis da da-ZmisaTvis daavadebis ris-ki 7-��%-ia; epilefsiiT daavadebuli dedebis Svilebi ufro xSirad avaddebian epilefsiiT, vidre daavadebuli mamebis Svilebi. simptomuri epilefsiiT daavadebulTa naTesaobaSi daavadebis riski gacilebiT dabalia _ 3-5%.

ra sixSiriT gvxvdeba epilefsia?epilefsiiT daavadebulia msoflio mosaxleobis �%. sx-

vadasxva qveynis epidemiologiuri maCveneblebis mixedviT misi gavrceleba meryeobs 4-dan �� daavadebulamde yovel �000 mosaxleze; epilefsia bavSvebSi ufro xSiria, vidre mozrdilebSi.

�55

ra ZiriTadi problemebi gvxvdeba epilefsiis dros?

• pirveli da mniSvnelovani problemaa gulyra da misi sixSire. amitom, pirvel rigSi, aucilebelia gulyre-bis Sewyveta Sesabamisi antikonvulsanturi preparatis SerCeviT. cnobierebis moulodnelad dakargvis dros, rodesac bavSvs ar aReniSneba gulyris ganviTarebis wi-naswari SegrZnebebi, generalizebuli tonur-klonuri, an tonuri krunCxvebis SemTxvevaSi maRalia bavSvis tra-vmuli dazianebis riski. es iwvevs ojaxis wevrebisa da bavSvis SiSebs krunCxvebis mimarT.

• bavSvis sicocxles safrTxe emuqreba epilefsiuri sta-tusis SemTxvevaSi. am dros saWiroa gadaudebeli same-dicino daxmareba, raTa bavSvi gamoyvanili iqnes am mZime mdgomareobidan.

• mniSvnelovan problemas warmoadgens socialur-fsiqo-logiuri faqtorebi. epilefsiiT daavadebuli bavSvis pirovnebis CamoyalibebaSi did rols asrulebs ojaxuri urTierTobebi da ojaxuri situacia, uaxloesi socia-luri garemos ganwyoba da sazogadoebis Sexedulebe-bi daavadebis mimarT. xSirad, ojaxi da Semdeg bavSvic fiqroben, rom maT dascineben, an zurgs Seaqceven imis gamo, rom gulyrebi aqvs. ojaxi axloblebTanac ki cdi-lobs damalos bavSvis daavadeba, mSoblebi cdiloben, bavSvi maqsimalurad iyos izolirebuli garemosagan, radgan dacul iqnas Seuferebel adgilebSi moulodne-li gulyrebisagan. xSirad, ojaxi zedmet mzrunvelobas iCens bavSvis mimarT, rac xels uwyobs mis Wirveul, ego-centrul, mouTmenel, an zedmetad damokidebul, une-bisyofo, Caketil pirovnebad Camoyalibebas. zogjer, gulyris SiSiT, mSoblebi cdiloben bavSvs yoveli sur-vili Seusrulon, riTac xels uwyoben misi fsiqopaTo-logiuri reaqciebis ganmtkicebas.

• epilefsiiT daavadebulebSi sxvadasxva SemecnebiTi una-rebis mqone bavSvebi gvxvdebian. bevrs aranairi proble-ma ara aqvs swavlaSi, an Semdeg _ SromiT saqmianobaSi, bevrs ki brwyinvale monacemebi aqvs. miuxedavad amisa, gvxvdeba epilefsiiT daavadebul bavSvTa kategoria, ro-

�56

melTac aReniSnebaT fsiqikuri ganviTarebis Seferxeba, swavlis problemebi. uestisa da lenoqs-gastos sindro-mebs Tan axlavs Zlieri CamorCena gonebriv ganviTareba-Si. sxva SemTxvevebSi, Tu Tavis tvinis dazianeba adreul asakSi moxda da gulyrebis kontrolic problemas war-moadgens, bavSvi CamorCeba ganviTarebaSi. Cvilobis asak-Si SeimCneva senso-motoruli funqciebis ganviTarebis CamorCena. adreuli bavSvobis periodSi aReniSnebaT CamorCena metyvelebis ganviTarebaSi. skolis periodSi bavSvs aqvs xanmokle mxedvelobiTi da smeniTi mexsiere-bis problemebi, yuradRebis koncentraciisa da gadana-cvlebis problemebi. azrovneba Senelebulia, rigidu-li, aseTi bavSvi ufro metad detalebsa da umniSvnelo wvrilmanebs aqcevs yuradRebas.

• gvxvdeba qcevisa da afeqturi sferos darRvevebi im bavS-vebsa da mozardebSi, romelTac daavadebis mZime mimdi-nareoba aqvT. epilefsiis dros bavSvebsa da mozardebSi SeiZleba SevxvdeT: �. maRal fsiqikur agznebadobas, �. sust emociur regulacias, ris gamoc bavSvis emociuri sfero arastabiluria, 3. negativizms, Wirveulobasa da brazian sijiutes, 4. agresiul qcevas, romelic zogjer ukontroloa, 5. depresiul simptomebs, daqveiTebul guneba-ganwyobas, 6. swraf feTqebadobas mcire winaaRm-degobisa da imedgacruebis SemTxvevaSi, 7. uiniciativo-bas, pasiurobas, umweobas.

rogor unda davexmaroT epilefsiis mqone bavSvs?pirvel rigSi, aucilebelia adekvaturi samedicino dax-

mareba. rac ufro adre daismeba swori diagnozi da daiwyeba daavadebis adekvaturi mkurnaloba, miT ufro efeqturia mkurnalobis Sedegi. bavSvis pirveladi gasinjva warmoebs nevropaTologis, ukeTes SemTxvevaSi epileftologis mier. axloblebi did daxmarebas uweven eqims sakuTari dakvirve-bebiT, gulyris detaluri aRweriT. diagnostikis mizniT bavSvs uniSnaven sxvadasxva saxis gamokvlevas: Tavis tvinis eleqtrul aqtivobas ikvleven eleqtroencefalografiuli (eeg) kvleviT. es gamokvleva periodulad meordeba, radgan eqimi, klinikur monacemebTan erTad, eeg monacemebis safu-

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Zvelze Rebulobs informacias mkurnalobis procesSi Tavis tvinis eleqtruli aqtivobis cvlilebebis Sesaxeb; zogjer saWiroa Tavis tvinis kompiuteruli tomografiisa da bir-Tvul-magnitur-rezonansuli gamokvlevebis warmoeba Tavis tvinis struqturuli mdgomareobis Sesafaseblad.

epilefsiis mqone bavSvs esaWiroeba: • yoveldRiuri cxovrebis adekvaturi reJimi, rac pirvel

rigSi Zilis reJimis regulirebas gulisxmobs. uZiloba uaryofiTad moqmedebs bavSvis nervul sistemaze, amas-Tan, aqveiTebs ra gulyrebisadmi mzaobis zRurbls, xels uwyobs gulyrebis aRmocenebas.

• wamlis daniSnuli dozis regularuli, zusti miReba, jeris gamotovebis gareSe.

• perioduli konsultacia eqimTan da gamokvleva.mniSvnelovani daxmarebaa bavSvis CarTva socialur cxov-

rebaSi, misi, rac SeiZleba, naklebi izolireba garemosagan, ojaxis wevrebis erTiani strategia aRzrdis sakiTxebSi.

bavSvis fsiqikuri ganviTarebis CamorCenis SemTxvevaSi, aucilebelia, neirofsiqologisa da fsiqologis konsul-tacia. rac ufro adre moxdeba bavSvis ganviTarebis Sefase-ba da daigegmeba fsiqologiuri da pedagogiuri daxmareba, miT ufro efeqturi iqneba igi.

sasurvelia, neirofsiqologiuri konsultaciebis peri-oduli warmoeba antiepilefsiur mkurnalobaze myofi yve-la adamianisTvis, radgan antiepilefsiur preparatebs, xan-grZlivi mkurnalobis fonze, gaaCnia kognitur funqciebze zemoqmedebis unari.

ra unda movimoqmedoT epilefsiuri gulyris dros?marTalia, didi gulyra sakmaod Semzaravad gamoiyure-

ba, magram sicocxlisaTvis saSiSi ar aris. am dros saWiroa bavSvi daawvinoT gverdze gulyris damTavrebamde da daak-virdeT gulyris mimdinareobas. TavqveS amoudoT rbili ni-vTi, riTac avicilebT Tavis travmas dartymebisagan. krun-Cxvis dros ar unda ecadoT xel-fexis iZulebiT gakavebas, pirSi, kbilebs Soris magari sagnis Cadebas enis mokvnetis Tavidan acilebis mizniT. am moqmedebebma SeiZleba kbile-

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bis, saxisa da kidurebis dazianeba gamoiwvios. gulyris damTavrebis Semdeg adamianis marto datoveba ar SeiZleba manam, sanam mas ar daubrundeba naTeli cnobiereba. didi gulyris xangrZlivoba 3-5 wuTs grZeldeba da eqimis gamo-Zaxeba aucilebeli ar aris. eqimis gamoZaxeba aucilebelia, Tu gulyra 5 wuTze met xans grZeldeba, aRiniSneba seriuli gulyrebi an epilefsiuri statusi (ix. zemoT). aseTi mdgo-mareoba bavSvisaTvis saxifaToa da specialur samedicino daxmarebas moiTxovs.

mcire gulyrebis dros yuradRebas iqcevs bavSvis areu-li, dabneuli mdgomareoba. eqimisaTvis sasargebloa dams-wris mier gulyris dawvrilebiT aRwera, radganac es mas diagnostikaSi exmareba.

gankurnebadia Tu ara epilefsia?epilefsiis mkurnalobis Tanamedrove saSualebebi im-

denad ganviTarda, rom sxvadasxva qveynebis monacemebiT pacientTa 70-80%-Si, epilefsiis xarisxisa da simZimis mi-xedviT, miiRweva gulyrisagan sruli gaTavisufleba. �0%-is mdgomareoba umjobesdeba, xolo �0%-Si mkurnaloba ara-efeqturia.

epilefsiuri gulyris yvela forma moiTxovs adekvatu-ri mkurnalobis droul dawyebas, raTa aRikveTos gulyre-bis sixSiris zrda da xeli SeeSalos daavadebis progress. gamojanmrTelebis albaToba didia, Tu gulyra ar meor-deba � wlis manZilze. epilefsia gankurnebulad iTvleba, Tu wamlis miRebis Sewyvetidan 5 wlis manZilze Seteva ar ganmeorda.

epilefsiis mkurnaloba, ZiriTadad, farmakologiuri preparatebiT warmoebs. am preparatebs antikonvulsantebs uwodeben. epilefsiis sxvadasxva forma sxvadasxva wamals moiTxovs, anu ar arsebobs preparati, romelic erTnairad Svelis epilefsiuri gulyris yvela tips. samedicino Tval-sazrisiT, ufro efeqturia erTi preparatiT mkurnaloba _ monoTerapia. mkurnaloba aucileblad unda mimdinareob-des eqimis zedamxedvelobis qveS da ar unda icvlebodes me-zoblebis, axloblebis, sxva pacientebis rCevebis gavleniT. epilefsiis mqone pirma eqimis mier daniSnuli wamlebi zus-

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ti odenobiTa da TanmimdevrobiT unda miiRos. man TviTne-burad ar unda Sewyvitos wamlis miReba gulyrebis Sewyve-tis Semdegac. wamlis dozis TviTneburi cvla, misi ucabe-di Sewyveta zrdis epilefsiuri gulyrebis ganaxlebis, an gaxSirebis saSiSroebas. epilefsiuri gulyrebis ganaxleba abaTilebs mkurnalobis efeqts da moiTxovs mkurnalobis sruliad axali gegmis SemuSavebas, rac gacilebiT rTulia.

epilefsiis mkurnaloba xangrZlivi procesia; is, ro-gorc wesi, ramdenime weli, xSirad 4-5 weli grZeldeba. gan-kurneba mxolod xangrZlivi da swori mkurnalobis safuZ-velzea SesaZlebeli, amitom didi moTminebaa saWiro.

Tu epilefsia mkurnalobisadmi mdgradia da adekvatu-ri medikamenturi Terapia gavlenas ar axdens gulyrebis sixSireze, maSin naCvenebia qirurgiuli operacia. gansakuT-rebul, e.w. ketogenur dietas bavSvebSi mimarTaven wamle-bisadmi rezistentuli epilefsiis SemTxvevaSi.

iseve, rogorc sxva wamlebs, antikonvulsantebsac aqvT moqmedebis gverdiTi efeqtebi. wamlis moqmedeba sakamod individualuria. amave dros, yovel antikonvulsants Ta-visi konkretuli gverdiTi efeqtebi aqvs. amitom, saWi-roa pacientis meTvalyureoba, sisxlis perioduli anali-zi, sisxlSi wamlis donis perioduli gansazRvra, RviZlis funqciebis gamokvleva. eqimisaTvis didi mniSvneloba aqvs mSoblis bavSvze dakvirvebis monacemebs: ra gavlenas axdens daniSnuleba bavSvis qcevaze, SemecnebiT aqtivobaze. Semec-nebiTi aqtivobis daqveiTeba, daRlilobis gancda, gulisre-vis, Tavbrusxvevis, Zilianobis Tu sxva gamovlinebebi eqimi-saTvis mniSvnelovani niSnebia wamlis dozis Sesacvlelad.

ra momavali aqvs epilefsiis mqone bavSvs?epilefsiis mqone pirebs, rogorc axla, aseve isto-

riuladac yovel profesiaSi SexvdebiT. mraval gamoCenil adamians hqonda es daavadeba: imperatorebs, mecnierebs Tu xelovnebis moRvaweebs, mwerlebsa Tu saxelmwifo moRva-weebs. sakamarisia davasaxeloT iulius keisari, T. dosto-evski.

profesiis arCevaSi epilefsiis mqone piri Tavisufalia da emyareba sakuTar interesebs, unarebsa da midrekilebebs.

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amave dros, gasaTvaliswinebelia erTi garemoeba: usafrT-xoebis mizniT, transportTan dakavSirebuli profesiebis arCeva ar aris mizanSewonili. aseve, mosaridebelia iseTi samuSaoebi, romlebic sxvadasxva cvlaSi, gansakuTrebiT Ramis cvlaSi muSaobas moiTxovs, radgan Zil-RviZilis rit-mis cvla da darRveva auaresebs epilefsiis mqone piris md-gomareobas. mozardisaTvis sportuli aqtivobebi savsebiT SesaZlebelia da sasargebloc, Tu is safrTxesTan ar aris dakavSirebuli, magaliTad, wylis sporti da samTo-saTxi-lamuri sporti. yovel konkretul SemTxvevaSi, epilefsiis formidan da xarisxidan, mozardis interesebidan gamomdi-nare, gadawyvetileba profesiis arCevis Sesaxeb individu-alur xasiaTs atarebs.

Tuki bavSvs swavlis problemebi aqvs, aReniSneba fsiqi-kuri ganviTarebis Seferxeba, misi interesebis Sesabamisad specialuri swavlebiTa da momzadebiT misTvis savsebiT misawvdomia raime konkretuli profesiis, an xelobis aTvi-seba. bavSvis momavalze zrunva niSnavs misi interesebisa da SesaZleblobebis gaTvaliswinebas, misi unarebis ganviTare-bisa da pirovnuli zrdisaTvis xelSewyobas.

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nayofis alkoholuri sindromi

ra aris nayofis alkoholuri sindromi?

nayofis alkoholuri sindromi (nas) viTardeba mucla-dyofnis periodSi, orsulis mier alkoholis Warbi, siste-maturi miRebis Sedegad da Seuqcevad xasiaTs atarebs. nas-i Tandayolili defeqtebis erTobliobaa, romelic moicavs centraluri nervuli sistemis disfunqcias, qala-saxis anomaliebs, qcevisa da fsiqikuri ganviTarebis darRvevebs. yuradsaRebia bavSvis pre- da postnataluri zrdis tempebis sagrZnobi CamorCena normasTan SedarebiT. rodesac bavSvs ar aReniSneba yvela klasikuri simptomi da sindromis mxo-lod zogierTi damaxasiaTebeli niSani aqvs, aseT formas uwodeben nayofis alkholur efeqts (nae).

riT xasiaTdeba nayofis alkoholuri sindromi?

fizikuri ganviTareba:• sxeulis mcire zomebi;• normasTan SedarebiT mniSvnelovnad mcire wona;• skeleturi deformaciebi: neknebisa da gulmkerdis Zv-

lebis deformacia, xerxemlis gamrudeba, menjis dis-lokacia, xelis an fexis TiTebis Sezrda (sindaqtilia), saxsrebis SezRuduli moZraoba, patara zomis Tavi (mik-rocefalia);

• saxis anomaliebi: Camoweuli quTuToebi, Tvalebis koor-dinirebuli moZraobis deficiti, cxviris CaRrmavebuli (Sevardnili) xidi, zeda tuCsa da cxvirs Soris CaRr-mavebis uqonloba, Ria sasa, patara yba, deformirebuli yurebi;

• Sinagani organoebis defeqtebi: gulis anomaliebi, Tirk-mlis defeqtebi, genitaluri malformaciebi.

fsiqikuri ganviTareba:• susti mexsiereba;• swavlis sirTuleebi;• impulsuroba;

�6�

• gafantuloba;• hiperaqtivoba;• codnisa da Cvevis ganzogadebis gaZneleba;• moqmedebis dagegmvis problema;• problemis gadaWris mwiri strategiebi;• gansjis unaris daqveiTeba;• metyvelebis problemebi, upiratesad mimarTuli me-

tyvelebis gagebis sirTuleebi;• qcevis darRvevebi.

Cvilobisa da skolamdeli asakis bavSvis Taviseburebani: dabadebis Semdeg, xangrZlivi drois ganmavlobaSi, nas-is mqone bavSvebi wonaSi klebuloben an ver imateben. axalda-badebulebSi da CvilebSi xSiria agznebadoba, Wirveuloba, gaRizianeba. bavSvebs uWirT wova, axasiaTebT mousvenari da fxizeli Zili. adreul asakSi erT-erTi mniSvnelovani maxa-siaTebelia motoruli funqciis ganviTarebis mniSvnelovani deficiti. bavSvebs kunTebis susti tonusi aqvT, tacebis refleqsi sustad aris gamoxatuli, gvian jdebian, dgebian, uWirT xoxva da cocva, gvian iwyeben siaruls. skolamdel asakSi maTi moZraobebi mouqneli da cudad koordinirebu-lia, uWirT TiTebiTa da xelebiT natifi moZraobebis ganx-orcieleba.

metyvelebis ganviTareba: skolamdeli asakis period-Si nas-is mqone bavSvebi sakmaod bevrs laparakoben da me-tyvelebis ganviTarebis Seferxeba cxadad ar vlindeba. miuxedavad imisa, rom isini TiTqos gasagebad metyveleben da saubarSi aqtiurebi arian, mainc gaaCniaT komunikaciis sirTuleebi, rac dialogis procesSi vlindeba. kerZod, aR-eniSnebaT mimarTuli metyvelebis gagebis problemebi.

socialuri ganviTareba: skolamdeli asakis nas-is mqone bavSvebi Zalian kontaqturebi, mosiyvaruleebi arian, uyvarT mofereba, eswrafvian fizikur kontaqts. sagnebTan urT-ierTobas urCevniaT adamianebTan urTierToba. isini Zalian gulubryviloni da mimndobni arian da naklebad swavloben raimes sakuTari gamocdilebiT. gansjis unaris daqveiTebis gamo, uWirT mizez-Sedegobrivi kavSirebis dadgena, SeiZleba, Zalian momabezrebelni da TavSeukavebelni iyvnen urTier-

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TobaSi. amis gamo, maT uWirT megobrebis SeZena da jgufur saqmianobaSi monawileobis miReba. mozard asakSi socialu-rad izolirebulni arian da uWirT tolebTan urTierTo-bis damyareba. mozrdilebs uWirT damoukidebeli cxovreba, aqvT alkoholizmis ganviTarebis didi riski.

qcevis problemebi: nas-is mqone bavSvebi skolamdel asakSi impulsurebi, hiperaqtiurebi da advilad agznebadni arian. skolis asakSi yuradRebis koncentraciis darRveva maT xels uSlis rogorc akademiur moswrebaSi, aseve so-cialur urTierTobebSi. aseT bavSvebSi xSiria stereoti-puli qcevebi, Zilis problemebi, Wamis darRvevebi, enurezi, SiSebi da mavne Cvevebi.

ra mizezebi iwvevs nayofis alkoholur sindroms?

aRniSnuli sindromis mizezia qalis mier orsulobis periodSi alkoholis miReba. dRemde daudgenelia alkoho-lis is raodenoba, romelic nayofis alkoholur sindroms gamoiwvevs. ar aris damtkicebuli, rom alkoholis mcire dozebi usafrTxoa. alkoholi cirkulirebs fexmZime qalis organizmSi da placentis saSualebiT xvdeba nayofSic. amis Sedegad nayofi veRar iRebs misTvis saWiro raodenobis Jangbads, rac gavlenas axdens misi centraluri nervuli sistemisa da sxva organoebis normalur Camoyalibebaze. na-yofis dazianebis simZime damokidebulia alkoholis miRebis intensivobaze da imaze, Tu ganviTarebis romel stadiaze moxda alkoholis zemoqmedeba.

ra sixSiriT gvxdeba nayofis alkoholuri sindromi?

aSS statistikuri monacemebiT, nebismieri kulturisa da socialuri jgufis yoveli 750 bavSvidan � bavSvi ibade-ba nayofis alkoholuri sindromiT, romelic gonebrivi CamorCenilobis erT-erTi mizezia. aRniSnuli sindromi Tanabari sixSiriT aReniSnebaT qalebsa da mamakacebs.

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ra ZiriTadi problemebi gvxvdeba nayofis alkoholuri sindromis dros?

• fizikuri problemebi, romlebic dakavSirebulia bavSvis zrdasTan, Sinagani organoebis anomaliebTan, sxvadasxva fizikur defeqtebTan da moiTxovs gadaudebel samedi-cino daxmarebas, xolo SemdgomSi mudmiv mkurnalobasa da samedicino meTvalyureobas.

• fsiqikuri ganviTarebis problemebi, rac mdgomareobs gonebrivi ganviTarebis CamorCenaSi, hiperaqtivobasa da impulsurobaSi, emociuri ganviTarebis problemebSi.

• swavlis problemebi: bavSvebs uWirT saskolo progra-mis aTviseba, xSir SemTxvevaSi zogadsaganmanaTleblo skolaSi swavla did problemebTanaa dakavSirebuli.

• saSiSroebas warmoadgens mozardebis socialuri izola-cia. maT uWirT tolebTan urTierToba, naklebad hyavT megobrebi, ver uReben alRos konkretul socialur situaciasa da sakuTar uaryofiT gamocdilebaze ver swavloben.

ikurneba Tu ara nayofis alkoholuri sindromi?

nayofis alkoholuri sindromi qronikuli da Seuqce-vadi xasiaTis mdgomareobaa. Tumca, bavSvebs simptomatu-rad mkurnaloben maTi Tandayolili defeqtebis xasiaTis mixedviT. xSirad saWiroa qirurgiuli Careva gulis Tanday-olili mankebis, saxis da kidurebis defeqtebis gamo. bavS-vebs mudmivi mkurnaloba esaWiroebaT centruli nervuli sistemis sxvadasxva xarisxiT dazianebis gamo.

amave dros, mniSvnelovania, bavSvTa ganviTarebis stimu-laciis mizniT, adreuli asakidanve maTi specialuri dax-mareba: fizikuri Terapia, okupaciuri Terapia, metyvelebis Terapia, fsiqologiuri konsultacia da fsiqologiuri daxmarebis programebi.

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rogor vaswavloT nayofis alkoholuri sindromis mqone bavSvs?

radganac nas-is mqone bavSvebs SemecnebiTi funqciebis ganviTarebaSi sxvadasxva saxis problema aqvT, maT swavlis procesis Sesatyvisi organizacia esaWiroebaT. amasTan, ga-mocdilebisa da Cvevebis aTvisebis mizniT, specialuri mid-goma saxlSic sWirdebaT.

bavSvebis swavlis unaris gasaumjobeseblad efeqturia:

• martivi, lakonuri instruqciebis micema;

• gakveTilis dayofa ramdenime monakveTad mcire Sesvene-bebiT, raTa bavSvma ukeT moaxdinos yuradRebis koncen-tracia;

• axali masalis an Cvevebis aTviseba unda xdebodes konkre-tul moqmedebaSi da bevri TvalsaCinoebiT. sjobs, das-wavlili Cvevis partniorTan erTad gameoreba. Semdeg ki damoukidebeli gameorebis waxaliseba. es procedura xSirad unda gameordes, amitom, mobezrebis Tavidan asacileblad, saWiroa bavSvis waxaliseba, raTa TviTon Seasrulos moqmedeba da misi warmatebis aRniSvna. amiT izrdeba bavSvis interesi;

• rodesac erTi aqtivoba sxva aqtivobiT unda Seicvalos, saWiroa bavSvis winaswari gafrTxileba;

• yovelTvis aRniSneT bavSvis warmateba da waaxaliseT da-moukidebeli saqmianobisaTvis;

• bavSvTan TamaSis dros ecadeT `gaaxmovanoT~ Tqveni mo-qmedebebi, isaubroT mkafiod da mSvidi toniT. TamaSi-sas gamoiyeneT bevri sagani, kubiki, plastelini, Tixa, fanqari, saRebavi. yovelive unda emsaxurebodes bavSvis iniciativis zrdas da misi sensomotoruli funqciebis ganviTarebas;

• bavSvs unda hqondes dRis myari reJimi;

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• bavSvis aRzrdis procesSi sasargebloa garkveuli we-sebis dadgena (dRis reJimi, qcevis wesebi). am wesebis Sexsenebisas mizanSewonilia mokle frazebis gamoyeneba mSvidi toniT;

• ar aris saWiro kamaTi da msjeloba ukve dadgenili we-sebis Sesaxeb. Tavidan ukarnaxeT, rogor unda moiqces, an ra gaakeTos. SeiZleba, ramdenjerme mogiwioT gameo-reba, nu gamoxvalT wyobidan, Tu sijiutes awydebiT. ec-adeT mSvidad gaameorebinoT ras moiTxovT bavSvisgan, SeaxsenoT, rom is SesaniSnavad axerxebs amis gakeTebas.

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tikuri aSliloba

ra aris tiki?

tiki sxvadasxva jgufis kunTebis swrafi, uneblie, gan-meorebiTi moZraobaa, romlebic sxeulis sxvadasxva nawilSi adamianisagan uneburad aRmocendeba.

skolamdeli asakis bavSvebis �5%-s sxvadasxva periodSi aReniSneba tikebi. nervuli sistemis ioli agznebadobis, emociurad mgrZnobiare bavSvebs, sxvadasxva stresul situ-aciaze reagirebisas, xSirad ewyebaT uneblie moZraobebi anu tikebi _ Tvalebis xamxami, mxrebis aCeCva, kisris moZ-raobebi da a.S. Semdgom bavSvebis umravlesoba gamodis am mdgomareobidan da tikebi ukvalod qreba. zog SemTxvevaSi ki uneblie moZraobebi didxans grZeldeba da Semawuxebeli xdeba bavSvisa da ojaxisaTvis.

ganasxvaveben martiv da rTul tikebs. aseve, motorul da vokalur tikebs.

martivi motoruli tikebi _ kunTebis uecari, xanmok-le moZraobebi: Tvalis xamxami, saxis kunTebis moZraobebi, grimasebi, mxrebis moZraobebi. am dros moZraoba swrafi da azrs moklebulia.

rTuli motoruli tikebi _ ufro neli uneblie moZra-obebia da rTul moqmedebebs Seicavs. mag. sagnebis xeliT mosinjva, sxvadasxva saxis Jestebi, fexebis bakuni, ukuRma siaruli, sirbilismagvari moZraobebi, cekviTi moZraobebi, xtunva, fexebisa da xelebis qneva, kopropraqsia _ uxamsi Jestebi.

martivi vokaluri tikebia _ uecari, gaurkveveli xmebi, Caxveleba, srutuni, burtyuni.

rTul vokalur tikebs garSemomyofni, rogorc wesi, gan-zraxul moqmedebad da uzrdel qcevad miiCneven. es aris si-tyvebisa da mTeli frazebis uecari, uneblie wamoyvireba; koprolalia _ socialurad miuRebeli, uxamsi sityvebisa da gamoTqmebis uneblie wamoyvireba. eqolalia _ sxvisi na-Tqvamis uSualo gameoreba.

tikuri aSlilobis sxvadasxva formebi arsebobs, romel-Ta diagnostikuri kriteriumebi warmodgenilia rogorc

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ICD-10, aseve DSM-IV diagnostikur saxelmZRvaneloebSi.

ICD-10 F95 tikuri aSliloba

DSM-IV-TR tikuri aSliloba

F95.0 gardamavali tikuri aSliloba

307.21 gardamavali tikuri aSliloba

F95.1 qronikuli motoruli da vokaluri tikuri aSliloba

307.22 qronikuli motoruli da vokaluri tikuri aSliloba

F95.2 kombinirebuli vokalu-ri da rTuli mravlobiTi motoruli tikuri aSliloba (J. de la turetis sindromi)

307.23 turetis aSliloba

F95.8 sxva tikuri aSliloba

F95.9 dauzustebeli tikuri aSliloba

307.21 dauzustebeli tikuri aSliloba

gardamavali tikuri aSliloba _ iwyeba adreuli bavSvo-bis asakSi da bavSvTa populaciis �8%-Si vlindeba. xasiaT-deba martivi da rTuli motoruli an/da vokaluri tikebiT, romlebic yoveldRiurad aRmocendeba 4 kviris ganmavlo-baSi, magram ara umetes �� Tvisa. ufro xSiri da gavrce-lebulia martivi motoruli tikebi, ufro iSviaTia rTuli da vokaluri tikebi. ZiriTadad, es mdgomareoba grZeldeba mxolod ramdenime kvira an Tve da ar axlavs specifikuri qceviTi problemebi. aRniSnuli mdgomareoba biWebSi 3-4-jer ufro xSiria. gardamavali tikuri aSliloba vlindeba �8 wlamde.

qronikuli motoruli da vokaluri tikuri aSliloba _ xasiaTdeba martivi an rTuli motoruli an vokaluri ti-kebiT, magram orive saxis tiki erTdroulad ar aRiniSneba. tiki yoveldRiurad mravaljer aRmocendeba � welze meti xnis manZilze. am periodis ganmavlobaSi tikisgan Tavisufa-li intervali SeiZleba iyos araumetes 3 Tvisa. qronikuli tikuri aSliloba �8 wlamde iwyeba da ar aris dakavSirebuli

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fiziologiur mdgomareobasTan (mag. intoqsikaciasa da wam-lebis borotad gamoyenebasTan) an samedicino mdgomareoba-sTan (mag. hentingtonis qorea, virusuli encefaliti).

gardamavali tikuri aSlilobis SemTxvevaSi tiki SeiZ-leba Seicvalos da erTi tipis tiki, mag. cxvirSi srutuni Secvalos Tavis moZraobiT, warbebis SeWmuxvna an Tvalebis paWuni ki TiTebis tkacuniT da a.S. qronikuli motoruli da vokaluri tikuri aSlilobisas ki tiki ar icvleba xangrZ-livi drois ganmavlobaSi.

tikis sixSire da gamoxatulebis xarisxi matulobs: stresis fonzedaRlilobis fonzemosvenebis mdgomareobaSi da relaqsaciis drossteroidebis, kofeinis, stimulantebis, antikonvulsan-

tebis gamoyenebis fonze (Black et al., 2006).

tikis sixSire mcirdeba:fizikur an gonebriv aqtivobaSi CarTvisas (mag. sportu-

li TamaSis, kompiuteruli TamaSis dros) gonebrivi davalebis Sesrulebisas naklebad stresul

situaciaSiZilSi

mniSvnelovania, rom tiki SesaZlebelia ar gamomJRavndes eqimTan pirveli vizitis ganmavlobaSi da saWiroa pacientis xelmeore viziti, aseve axloblebis dakvirvebis Sedegebi.

diferencialuri diagnostikis mizniT aucilebelia ti-kis gansxvaveba sxva motoruli darRvevebisagan da mdgoma-reobebisgan, kerZod:miokloniisgan, rac kunTebis jgufebis uecar SekrToma-

Si vlindeba _ tikisgan gansxvavebiT miokloniis Sekaveba SeuZlebelia;

qoreatuli moZraobisgan, rac kunTebis moulodnel, Wiisebr, daklaknil uneblie moZraobaSi vlindeba;

kunTTa distoniisgan;tremorisagan;stereotipuli moZraobis aSlilobisgan _ stereotipu-

li, ritmuli, ufunqcio uneblie moZraobebi, romlebic ar warmoadgenen romelime nevrologiuri an fsiqiuri

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daavadebis klinikuri suraTis simptoms (Black et al., 2006).

tikuri aSliloba SeiZleba iyos pirveladi da meoradi.pirveladi tikuri aSlilobebia Jil de la turetis sin-

dromi, gardamavali da qronikuli tikuri aSlilobebi. meoradi tikuri aSliloba romelime somaturi an ner-

vuli mdgomareobis Tanmxlebi simptomia. amitom aucile-belia gamoiricxos hiperTireozi, beta-hemolituri strep-tokokuri infeqcia yelSi, eqstrapiramiduli motoruli darRvevebi, wamlebiT intoqsikacia.

ra sixSiriT gvxvdeba tikuri aSliloba?

zusti epidemiologiuri monacemebi arsebobs mxolod de la turetis sindromis gavrcelebasTan dakavSirebiT. mwiri monacemebia gardamavali da qronikuli tikuri aSlilobis prevalensis Sesaxeb. aSS-s monacemebiT gardamavali tiku-ri aSliloba sxvadasxva epidemiologiuri kvlevis mixedviT gvxvdeba bavSvebis 3-�5%-Si. qronikuli tikuri aSliloba ufro xSirad gvxvdeba biWebSi.

ra ZiriTadi problemebia tikuri aSlilobis dros?tikuri aSliloba, pirvel rigSi, gavlenas axdens bavSvis

me-s cnobierebis Camoyalibebasa da TviTSefasebaze. bavSvi Tavs uxerxulad grZnobs iseTi moZraobebisa da moqmedebe-bis gamo, rac misda uneburad aRmocendeba.

uneblie moZraobebi ipyrobs garSemomyofTa yuradRebas, ucnaur STabeWdilebas tovebs maTze da maTi interpreta-cia, xSirad, arasworia. kerZod, bavSvi SeiZleba Tanatolebis dacinvis obieqti gaxdes da amis gamo Caiketos, aRar hqon-des skolaSi siarulis survili an hqondes dacviTi agresiu-li qceva. ufrosebi – mSoblebi da maswavleblebi xSirad fiqroben, rom bavSvi mousvenaria da ucnaurad iqceva spe-cialurad maTi gamowvevis mizniT. gansakuTrebiT es exeba rTul da vokalur tikebs, romlebic damkvirvebelze tove-ben nebiTi moqmedebis STabeWdilebas. Sesabamisad, mSoblebi

�7�

da maswavleblebi mudmivad SeniSvnas aZleven bavSvs da miu-TiTeben, rom misi qceva miuRebelia. aseTi damokidebuleba kidev ufro auaresebs bavSvis mdgomareobas, aqveiTebs mis TviTSefasebas, iwvevs danaSaulis gancdas, xSirad ki _ umar-Tav, opoziciur qcevas. tiki bavSvisaTvis iarliyis miwebebi-sa da misi stigmatizaciis mizezi SeiZleba gaxdes. yovelive es xels uSlis bavSvs rogorc swavlaSi, aseve socialur ur-TierTobebSi da zogadad socialur adaptaciaSi.

qronikul motorul da vokalur tikur aSlilobas Sei-Zleba axldes:obsesiur-kompulsiuri aSliloba; yuradRebis deficitisa da hiperaqtivobis sindromi; qceviTi aSliloba.

aRniSnuli mdgomareobebi, xSirad, qronikuli tikuri aSlilobis komorbidulia da arTulebs mis mimdinareobas.

riT xasiaTdeba obsesiur-kompulsiuri aSliloba?tikuri aSlilobis mqone pirebSi �0-jer ufro xSiria

obsesiur-kompulsiuri aSliloba vidre generalur popu-laciaSi.

obsesiur-kompulsiuri aSliloba, anu akviatebis mdgo-mareoba xasiaTdeba, erTis mxriv, akviatebuli azrebiTa da impulsebiT, meores mxriv, akviatebuli azrebiT gamowveuli SfoTvis Sesamcireblad aRmocenebuli iZulebiTi ritu-alebiT.

akviatebis yvelaze gavrcelebuli saxeebia dabinZurebi-sa da dasneulebis SiSi; katastrofebis SiSi _ xanZari, avad-myofoba, sikvdili; simetriis, wesrigis, sizustis, akviate-buli crurwmenebi, bednieri da ubeduri ricxvebis garCevis survili. iZulebiTi moqmedebebidan yvelaze gavrcele-bulia: dabana, ganmeorebadi moqmedebebi, xSiri Semowmeba, Sexeba, Segroveba, mowesrigeba. ymawvilTa umetesobas Seu-Zlia sazogadoebaSi iZulebiTi moqmedebebisagan Tavis Se-kaveba.

akviatebuli mdgomareoba da iZulebiTi moqmedeba erT-droulad vlindeba SemTxvevaTa 60%-Si. 40%-Si ki iZulebi-Ti moqmedeba akviatebis gareSe gvxvdeba. SemTxvevaTa didi nawili Tan axlavs sxva darRvevebs: Jil de la turetis

�7�

sindroms, SfoTvas, depresias. sxva Tanmxlebi darRvevebia bulemia, anoreqsia, ganviTarebis Seferxeba.

bavSvebis �-�%-s aqvs akviatebisa da iZulebiTi moqmedebis sindromi. yvelaze xSirad sindromi vlindeba gviandeli bavSvobisa da siymawvilis periodSi. mdgomareoba SeiZleba iyos epizoduri, an qronikuli. 3-dan � SemTxveva gankur-nebadia. �0-dan � SemTxveva ki ar emorCileba mkurnalobas.

akviatebisa da iZulebiTi moqmedebis sindromi gansx-vavdeba bavSvebis normaluri ritualebisagan, akviatebul azrebis gareSe. igi xSiria skolamdel asakSi da qreba 8-9 wlisaTvis. akviatebisa da iZulebiTi moqmedebis sindromi xSirad tikuri aSlilobis komorbidulia.

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Jil de la turetis sindromi

ra aris Jil de la turetis sindromi?

es aris qronikuli daavadeba, romelic xasiaTdeba mo-toruli da vokaluri tikebiT. daavadeba mudmiv xasiaTs atarebs perioduli SemsubuqebiT Tu CacxrobiT. Zalian iS-viaTia monacemebi sruli gamojanmrTelebis Sesaxeb. xSiria monacemebi imis Sesaxeb, rom mozrdilobis asakSi simpto-mebi sustdeba.ZiriTadi maxasiaTeblebia:

• mravaljeradi rTuli motoruli da vokaluri tikebi, romlebic SeiZleba erTdroulad aRmocendebodnen an vlindebodnen monacvleobiT (kriteriumi A).

• tikebi dReSi bevrjer aRmocendeba (Cveulebriv, Setevis saxiT), yoveldRe, an garkveuli periodulobiT � welze meti xnis ganmavlobaSi; am drois manZilze tikisgan Ta-visufali, uwyveti periodi 3 Tveze meti ar aris (krite-riumi B).

• daavadebis dasawyisi �8 wlamdea (kriteriumi C).

• daavadeba ar aris gamowveuli centraluri nervuli sistemis intoqsikaciiT an infeqciiT (kriteriumi D).

• tikebis raodenoba, sixSire, xasiaTi da simZime ar aris mudmivi da droTa ganmavlobaSi icvleba.

daavadebas ewoda frangi nevrologis Jil de la ture-tis saxeli, romelmac me-�9 saukunis bolos pirvelad aR-wera igi da daaxasiaTa rogorc samedicino mdgomareoba.

daavadebis simptomebis dasawyisi meryeobs �-dan �5 wlamde, yvelaze xSirad dafiqsirebulia 7 wlis asaki. �� wlisaTvis pacientTa 96%-s ukve gamoxatuli aqvs mocemuli sindromisaTvis damaxasiaTebeli yvela simptomi.

rogorc wesi pirveli simptomebi martivi motoruli tikebia.

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riT xasiaTdeba Jil de la turetis sindromi?

• sindroms axasiaTebs martivi da kompleqsuri motoruli tikebi.sindromisaTvis gansakuTrebiT damaxasiaTebelia mar-

tivi da rTuli vokaluri tikebi.

• pacientTa �0-dan 45%-saTvis damaxasiaTebelia eqola-lia _ sxvisi sityvebisa da xmebis imitacia, gameoreba, �0-dan 35%-Si gvxvdeba eqopraqsia _ sxvaTa moZraobebis gameoreba da imitacia, �0%-Si ki gvxvdeba palilalia _ sityvis bolo asoebis, an winadadebis bolo-sityvis gameoreba. pacientTa 8-�5%-s aqvs koprolalia _ uxamsi sityvebis da frazebis uneblie wamoZaxili, xolo �-6%-s ki _ kopropraqsia _ uneblie uxamsi Jestebi da moZrao-bebi.

• cxovrebis ganmavlobaSi uneblie moZraobebis xasiaTi icvleba _ Zveli tikebi SeiZleba gaqres, gaCndes axali tikebi.

• sindromis uCveulo maxasiaTebelia is, rom adamians didi Zalisxmevis Sedegad SeuZlia tikebis kontroli drois garkveuli periodis ganmavlobaSi. rogorc wesi, aseTi Sekavebis periods mosdevs tikebis gaormagebuli Setevebi.

• tiki qronikuli xasiaTisaa, Tumca, zogjer, SeiZleba gaqres erTi dRiT, kviriT, ramdenime TviT, magram ara umetes 3 Tvisa.

• am sindromis dros yvela saxis tiki Zlierdeba da mwvav-deba SfoTvis, stresis, daRlilobis, uZilobis, alko-holis Warbi miRebis dros.

• pacientTa 85%-s mkurnalobis fonze aqvT remisia an mniSvnelovani gaumjobeseba, gansakuTrebiT mozrdilo-bis asakSi; �5%-s ki mkurnalobis fonze ar aReniSneba mdgomareobis gaumjobeseba an xdeba simptomebis gau-areseba.

• garegnulad rTuli motoruli da vokaluri tikis mqo-

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ne adamiani aRiqmeba rogorc mousvenari, fusfusa, Sfo-Tiani, xandaxan rogorc uzrdeli, uxamsi, masxara, oin-bazi. radganac zogierT situaciaSi, an garkveuli peri-odis ganmavlobaSi tiki qreba, garSemomyofebi askvnian, rom es bavSvis nebisyofazea damokidebuli; Sesabamisad, iqmneba STabeWdileba, rom bavSvi TamaSobs, an Tavxedobs da araseriozulad iqceva.

• Jil de la turetis sindroms, xSirad, Tan axlavs hipe-raqtivoba, yuradRebis koncentraciis unaris daqveiTe-ba, qceviTi aSliloba.

• am sindromis mqone adamianebi gansakuTrebiT midrekilni arian depresiisadmi. es nawilobriv SeiZleba imiT aixs-nas, rom Jil de la turetis sindromis mqone adamianebs qronikulad aqvT socialurad miuRebeli gamovlinebe-bi, romelTac ver akontroleben da maTgan gaTavisuf-lebis imedi ar aqvT. bavSvebSi xSiria Zlieri SfoTva, SiSebi, enurezi.

• J. de la turetis sindromTan komorbidulia obsesiur-kompulsiuri aSliloba. marTalia, am sindromis mqone bavSvebs, SeiZleba, naklebad hqondeT gamoxatuli ak-viatebuli azrebi da qcevebi, magram xSiria riTmomania (Tvla), simetriaze zrunva, mowesrigebis mudmivi survi-li, yvelafris akviatebuli Semowmeba, sxvadasxva ritu-alebi.

• Jil de la turetis sindromi ar axdens gavlenas bavSvis inteleqtualur ganviTarebaze. gonebrivi ganviTare-biT is ar gansxvavdeba Tanatolebisagan. amave dros, am sindromis mqone bavSvebs SeiZleba hqondeT problemebi mxedvelobiT-sivrciTi funqciebis momwifebaSi (sivr-ciTi mimarTebebis cnoba, sivrciTi orientacia, mxed-velobiT-sivrciTi informaciis gadamuSaveba), natifi motoruli moqmedebebis SesrulebaSi, axasiaTebdeT gafantuloba, impulsuroba. aseTi bavSvebi Zalian mgrZ-nobiareni arian emociuri stresorebisadmi.

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ra iwvevs Jil de la turetis sindroms?

dReisaTvis cnobilia, rom sindromis safuZveli nei-robiologiuri xasiaTisaa. neirovizualuri gamokvlevebis mixedviT, SesamCnevi cvlilebebia upiratesad Tavis tvinis Semdeg struqturebSi: nuSisebri birTvi, sartylis xveuli da bazaluri gangliebi (qerqqveSa struqturebi) da Sublis wilebi. erTi hipoTezis mixedviT am cvlilebebs safuZvlad udevs centraluri nervuli sistemis neirotransmiteru-li agentebis, gansakuTrebiT dofaminis cvlis darRveva. kerZod, neiroqimiuri gamokvlevebis mixedviT, sindromis paTofiziologiuri meqanizmia dofaminis Warbi gamoyofa dofaminur postsinafsur receptorebSi. dRes ar aris cno-bili neirotransmiteruli cvlis darRvevis zusti meqani-zmi Jil de la turetis sindromis dros.

neirotransmiteruli cvlis darRvevis Sedegad ga-mowveuli neirofiziologiuri deficitia prefrontalur-subkortikul motorul wreebSi Sekavebis darRveva.

arsebobs sindromis genetikuri mizezebis hipoTezac. dReisaTvis, ojaxuri istoriebis analizis safuZvelze, ar-sebobs varaudi daavadebis autosomur-dominanturi gziT gadacemis Sesaxeb. Tumca, es hipoTeza damtkicebuli ar aris.

sxvadasxva gamokvlevebis mixedviT Jil de la turetis mqone pirebis naTesavebSi xSirad SeiZleba aRmoCndes mania-kalur-depresiuli fsiqozi, akviatebis nevrozi, panikuri aSliloba.

ramdenad xSiria Jil da la turetis sindromi?

sindromi gvxvdeba yvela kulturaSi. sxvadasxva qveyne-bis monacemebis mixedviT gavrcelebis sixSire gansxvavebu-lia bavSvebsa da mozrdilebSi. bavSvebSi prevalensia 5-30 : �0000 mosaxleze. mozrdilebSi ki gavrcelebaa �-� : �0000. yoveli 4 SemTxvevidan 3 mamakacia. qalebSi aRniSnuli sin-dromi iSviaTad gvxvdeba.

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ra ZiriTadi problemebia Jil de la turetis sindromis dros?

• tikis ganmeorebiTi xasiaTi, droSi misi Sesusteba-gaZ-liereba, xSirad, socialurad miuRebeli xasiaTi bevr gaugebrobas warmoSobs.

• ZiriTadi problema mainc mSoblebisa da maswavleble-bis mxridan aRniSnuli sindromis swor, adekvatur gage-baSia. ukontrolo tikebi bavSvs cxovrebas urTulebs. ufrosebi Tvlian, rom igi jiutia, uzrdeli da masxara. tolebma ki, SeiZleba, misi ucnauri moZraobebis gamo dascinon. yovelive es uaryofiTad moqmedebs bavSvis pirovnebis, misi emociuri sferos Camoyalibebaze.

• problemaa bavSvis mier sakuTari Tavis aRqmac. bavSvi Tavs sxvebs adarebs da rwmundeba, rom Zalian gansxva-vebulia tolebisagan. xSirad, ususurobisa da SfoTvis gancda ipyrobs, radgan, misda uneburad, sazogadoebaSi SeiZleba miuRebeli, araadekvaturi moqmedeba ganaxor-cielos.

• am sindromis dros aseve mniSvnelovani problemebia de-presiuli foni da bavSvis izolacia.

• saswavlo procesTan dakavSirebuli problemebi ori sa-xisaa:

�. gakveTilze bavSvis aqtivobasa da produqtulobas, SeiZleba, xeli SeuSalos yuradRebis koncentraciis me-ryeobam da gamofitvam.

�. bavSvs, mxedvelobiT-sivrciTi unarebis deficitis gamo, SeiZleba hqondes weris, kiTxvis an ariTmetikuli ope-raciebis Sesrulebis siZneleebi. bavSvi am Cvevebis asa-Tviseblad, SeiZleba, saWiroebdes ufro met drosa da specialur midgomas.

rogor SeiZleba davexmaroT Jil de la turetis sindromis mqone pirebs?

• pirvel rigSi, aucilebelia sindromis swori diag-nostireba, rac arc ise advilia. Cveulebriv, tikebi pirvelad 6 wlis asakisaTvis Cndeba (da yovelTvis ��-

�78

�3 wlamde gamovlindeba). es martivi motoruli tikebia. mogvianebiT gamovlindeba vokaluri da ufro kompleq-suri xasiaTis tikebi, romlebic cvlis martiv motorul tikebs. amitom diagnozis dasma xangrZlivi procesia. es diagnozi ar daismeba tikis pirveli aRmocenebisTanave, radganac mcirewlovan bavSvebs xSirad axasiaTebT mar-tivi motoruli tikebi, romlebic droTa ganmavlobaSi qreba (gardamavali tikuri aSliloba). aucilebelia Jil de la turetis sindromis samedicino diferencialuri diagnozi mioklonur epilefsiasTan da kunTTa made-formirebel distoniasTan. amitom Jil de la turetis sindromis mqone pirebs aucileblad esaWiroebaT peri-oduli samedicino gamokvleva.

• bavSvisaTvis didi daxmarebis gaweva SeuZlia ojaxisa da maswavleblebis konsultacias daavadebasTan dakavSire-biT, raTa maT mcdari Sexeduleba ar CamouyalibdeT bavSvis Sesaxeb. im SemTxvevaSi, rodesac bavSvs sirTu-leebi aqvs swavlaSi, aucilebelia, misi individualuri daxmareba, gansakuTrebiT, mxedvelobiT-sivrciTi da mxedvelobiT-motoruli problemebis arsebobis SemTx-vevebSi.

• Tu bavSvs qceviTi aSliloba an emociuri problemebi aqvs, aucilebelia misi konsultacia fsiqologTan, saWiroebis SemTxvevaSi _ fsiqologiuri daxmarebis or-ganizeba specialuri fsiqologiuri programis saxiT.

rogoria Jil de la turetis sindromis mkurnaloba? gankurnebadia Tu ara?

Jil de la turetis sindromi qronikuli daavadebaa da misi sruli gankurneba dReisaTvis SeuZlebelia. miuxedavad amisa, arsebobs am sindromis mkurnalobis ori strategia: medikamenturi da socialur-fsiqologiuri. mkurnalobis strategia damokidebulia daavadebis simZimeze, anu simp-tomebis gamovlenis xarisxsa da garTulebebze. Cveulebriv, sindromis mkurnaloba moicavs uSualo da Tanmxlebi prob-lemebis mkurnalobas.

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sindromisaTvis damaxasiaTebeli simptomebis ioli gamoxatulebis SemTxvevaSi, ZiriTadi aqcenti keTdeba di-agnostikis procesze, daavadebis sakiTxebTan dakavSirebiT ojaxis informirebasa da ganaTlebaze, sakuTari mdgomare-obis Sesaxeb bavSvis gaTviTcnobierebaze. aseT dros medika-menturi mkurnaloba ar aris rekomendebuli da sakmarisia eqimTan Tu fsiqologTan ramdenime konsultacia.

saSualo da Zlieri xarisxis Jil de la turetis sin-dromis SemTxvevebSi, romlebsac xSirad axlavs hiperaq-tivoba da yuradRebis deficiti, akviatebuli mdgomareo-bebi da emociuri regulaciis problemebi, aucilebelia, medikamenturi da fsiqologiuri kombinirebuli daxmareba. medikamenturi Terapia gulisxmobs pirvel rigSi tikebis da Tu saWiroa komorbiduli depresiis, SfoTviTi aSlilobis, obsesiur-kompulsiuri aSlilobis, yuradRebis deficitis, impulsurobisa da hiperaqtivobis simptomebis sawinaaRm-dego preparatebiT mkurnalobas.

tikebis kontrolisaTvis yvelaze gavrcelebuli da sa-medicino mtkicebulebebiT dadasturebuli farmakologi-uri mkurnalobaa dofaminis D2 receptorebis antagonisti neiroleptikebiT (haloperidoli, pimozidi), atipuri nei-roleptikebiT (risperidoni, ziprasidoni). am ukanasknelT naklebi gverdiTi efeqtebi aqvT klasikur neiroleptikeb-Tan SedarebiT.

amasTan, aucileblad unda iyos gaTvaliswinebuli Jil de la turetis mqone pirebis maRali mgrZnobeloba nei-roleptikuri preparatebisa da maTi gverdiTi efeqtebis mimarT, ris gamoc aRniSnuli preparatebi Zalze frTxilad da dabali dozebiT unda dainiSnos da mkurnalobaSi unda CairTos is preparatebic, romlebic tikebis samkurnalo me-dikamentebis gverdiT efeqtebs gaaneitralebs.

medikamentur mkurnalobasTan erTad, aucilebelia bavSvisa da ojaxis fsiqologiuri konsultireba, bavSvis fsiqologiuri daxmareba qceviTi Terapiis, kognituri re-abilitaciisa Tu sxva damxmare fsiqologiuri meTodebis gamoyenebiT.

�80

rogor vaswavloT Jil de la turetis sindromis mqone bavSvs?

mravalferovani motoruli da vokaluri tikebis gamo bavSvebi Zalian ucnaurad gamoiyurebian. maT SeuZliaT ti-kis garkveuli periodiT kontroli, magram mTeli maTi en-ergia da yuradReba amaze ixarjeba, ris gamoc gakveTilis mimdinareobaSi naklebad arian CarTulni.

Jil de la turetis sindromis mqone bavSvebs, maTi Tana-tolebis msgavsad, sxvadasxva niWi da interesebi aqvT; maTi in-teleqtualuri ganviTareba asaks Seesabameba. miuxedavad amisa, am sindromis mqone bavSvebi sirTuleebs awydebian skolaSi swavlisas; maTi gaTvaliswineba aucilebelia bavSvebis warmate-biT swavla-aRzrdis procesSi. bavSvebs SeiZleba hqondeT:• SemecnebiTi problema, rac gamoixateba yuradRebis kon-

centraciis unaris daqveiTebaSi, mxedvelobiT-sivrciTi informaciis gadamuSavebis problemebSi.

• socialuri problema, romelic bavSvis pirovnul-emociuri sferos CamoyalibebasTanaa dakavSirebuli. ufrosebi da klaselebi ver igeben bavSvis mdgomareo-bas. maswavleblebi uzrdel da masxara bavSvad Tvlian, bavSvebi ki dascinian. es xSirad iwvevs bavSvis izola-cias, depresiul fons, agresiul qcevas.aRniSnuli sirTuleebis daZleva SesaZlebelia, Tu bavS-

vs gakveTilze eqneba Sesvenebis ufleba, ufro meti dro miecema davalebis Sesasruleblad. saxlSi, saSinao dava-lebebis momzadebisas, mizanSewonilia drois mcire mon-akveTebad dayofa: mag. erT davalebaSi ramdenime magaliTis gakeTeba, Semdeg dasveneba.

maswavleblis mxridan aseTi bavSvebis mxardaWeras, dac-invisa da gaugebrobebis profilaqtikis mizniT klasTan spe-cialur muSaobasa da maswavleblis codnas sindromis Tavise-burebaTa Sesaxeb didi mniSvneloba aqvs bavSvis skolisadmi dadebiTi ganwyobis SemuSavebasa da saskolo warmatebaSi.

rodesac bavSvs aReniSneba mxedvelobiT-sivrciTi fun-qciebis deficiti da amis gamo uWirs wera-kiTxvis aTviseba, esaWiroeba specialuri programa, romelic misi susti da Zlieri mxareebis gaTvaliswinebiT unda iqnas Sedgenili.

�8�

qceviTi aSliloba

ra aris qceviTi aSliloba?

fsiqologTan mimarTvis sababs SemTxvevaTa �/3-Si qcevis problemebi warmoadgens.

bavSvobis asakis darRvevebidan qceviTi aSliloba yvelaze `ZviradRirebuli~ paTologiaa:

• pirvel rigSi, imitom, rom naklebad emorCileba mkur-nalobas;

• qcevis problemebis mqone bavSvTa 60%-s cudi prognozi aqvs: aseTi bavSvebi kriminaluri qcevis, asocialuri pirovnuli aSlilobis, alkoholisadmi da narkotikebi-sadmi midrekilebis mqone pirTa maRali riskis jgufs warmoadgenen.

• qceviTi aSliloba gadaecema Taobidan Taobas, rac ar niSnavs genetikur memkvidreobas misi pirdapiri mniSvne-lobiT, aramed igulisxmeba, rom qceviTi aSlilobis mqone pirovnebis mier aRzrdil bavSvs qcevis prob-lemebis aRmocenebis didi albaToba aqvs.

`qceviTi aSliloba~ fsiqiatriuli terminia bavSvebis da mozardebis iseTi antisocialuri qmedebebis aRsaniSna-vad, romlebic zians ayenebs sxva adamians, sxvis da sakuTar qonebas da qronikuli xasiaTi aqvs.

klasifikacia

qcevis problemebis mravalferonebas Semdegi parame-trebi ganapirobebs:

• simZime _ ioli da iSviaTi gamovlinebidan mZime da xSir gamovlinebamde;

• qronikuloba _ mcire periodidan xangrZliv peri-odamde;

• mudmivoba _ skolaSi, saxlSi, sazogadoebaSi;

• problemebis dawyebis asaki _ bavSvobis asakidan ymawvi-

�8�

lobis asakamde;

• sicruis xarisxi;

• tolebis gavlena qceviT aSlilobaze: socializebuli qcevis problemebi, erTeuli qceviTi sirTuleebi;

• yuradRebis problemebis arseboba-ararseboba;

• hiperaqtivobis problemebis arseboba-ararseboba;

• depresiisa da guneba-ganwyobis sxva problemebis arse-boba-ararseboba;

• swavlis specifikuri siZnelebis arseboba-ararseboba;

• ojaxis dezorganizaciis xarisxi.qceviTi aSlilobis yvelaze gavrcelebul klasifika-

ciebs warmoadgens DSM-IV da ICD-10. isini gansxvavebulad iTvaliswinebs zemoaRniSnul parametrebs. orive sistemaSi calke gamoyofilia Seguebis gardamavali darRvevebi, rac qcevis problemebSi vlindeba da mudmivi an xangrZlivi xa-siaTi aqvs. unda iTqvas, rom klinikur praqtikaSi Seguebaze reaqciasa da qceviT aSlilobas Soris gansxvaveba yovel-Tvis ar aris cxadi. multivariaculi gamokvlevebis mixed-viT Seguebis gardamavali darRvevebi eqsternalizebuli qcevis problemebis farglebSi gvxvdeba.

aseve, qceviTi aSlilobisgan ganasxvaveben opoziciur-deviantur qcevas; ukanaskneli SedarebiT ioli, perioduli xasiaTisaa da ganviTarebis TvalsazrisiT, pirvelis winapi-robas warmoadgens.

ICD-10-Si Tanatolebis qcevis problemebze zegavlenis TvalsazrisiT ganasxvaveben socializebul da arasocili-zebul qceviT aSlilobebs; DSM-IV-Si ki qceviTi aSlilobis qvetipebs ganasxvaveben maTi dawyebis asakis _ bavSvobis, an siymawvilis asakis mixedviT. ICD-�0-Si qceviTi aSliloba ko-morbidulia ADHD _ sTan da depresiasTan calke mdgomareo-bad gamoiyofa. am sistemaSi, gansxvavebiT DSM-IV-sgan, aseve, calke gamoyofen Sereul qceviT da emociur aSlilobas.

TiToeul sistemaSi komorbiduli swavlis problemebi da ojaxuri sirTuleebi sxvadasxva ganzomilebaze kodir-deba. arc erT sistemaSi ar ganasxvaveben Ria da faruli agresiiT qcevis darRvevis qvetipebs.

�83

qceviTi aSlilobebis klasifikacia

ICD-10qceviTi aSliloba F91

DSM-IVqceviTi aSliloba

312.8

F91.0 qceviTi aSliloba, ganpiro-bebuli ojaxis konteqstiT

F91.1 arasocializebuli qceviTi aSliloba

F91.2 socializebuli qceviTi aSliloba

F91.3 opoziciuri-devianturi qceviTi aSliloba

313.81 opoziciur-devianturi qceviTi aSliloba

F91.8 sxva qceviTi aSliloba

F91.9 dauzustebeli qceviTi aSliloba

9.9 dauzustebe-li umarTavi qcevi-Ti aSliloba

Sereuli qceviTi da emociuri aSliloba F92

SesaZlebelia kodi-reba rogorc 312.8 qceviTi aSliloba an 300.9 araspecifi-kuri fsiqiuri aSli-loba (arafsiqotu-ri)

F92.0. depresiuli qceviTi aSliloba

F92.8 sxva Sereuli qceviTi da emociuri aSliloba

F92.9 dauzustebeli Sereuli qceviTi da emociuri aSliloba

�84

ra sixSiriT gvxvdeba qceviTi aSliloba?

populaciaSi qceviTi aSliloba da opoziciuri-devian-turi (daumorCilebeli) qceva 4-�4%-mde SemTxvevaSi gvxvdeba da maTi sixSire damokidebulia im kriteriumebze, ris safuZ-velzec xdeba misi gansazRvra. qceviTi aSliloba emociur aSlilobasTan SedarebiT �-jer ufro xSiria; biWebSi ufro xSirad gvxvdeba, vidre gogonebSi da sqesTaSorisi propor-cia Sesabamisad meryeobs 4:�-dan �:�-mde. qceviTi aSliloba xSirad komorbidulia emociur aSlilobasTan da yuradRebis deficitisa da hiperaqtivobis sindromTan (ADHD).

rogor xdeba qcevis aSlilobis diagnostireba?

opoziciuri-devianturi qcevis darRvevis kriteriumebi DSM-IV, ICD-10 da aSenbaxis CBC sistemaSi

DSM-IVa. negatiuri, mtruli da daumorCilebeli qcevis paternebi,

romlebic minimum 6 Tves grZeldeba da Semdegi niSnebi-dan 4 maTgani maincaa saxeze:

• xSirad gamodis wyobidan;

• xSirad epasuxeba ufrosebs;

• xSirad ar emorCileba ufrosebis moTxovnebsa da we-sebs;

• xSirad Tavs gamiznulad abezrebs sxvebs;

• xSirad sxvebs abralebs sakuTar Secdomebsa da uwe-so qcevas;

• xSirad swyins da Riziandeba;

• xSrad ipyrobs aRSfoTeba da sibraze;

• xSiradaa RvarZliani, avi da SurismaZiebeli.

b. qcevis darRveva iwvevs klinikurad mniSvnelovan darRve-vas socialur, akademiur an SromiT saqmianobaSi.

�85

g. es qcevebi ar aRmocendeba mxolod fsiqoturi mdgomare-obis an guneba-ganwyobis darRvevebis dros.

d. es kriteriumebi gamoricxavs qceviT aSlilobas, an Tu pirovneba �8 welze ufrosia - antisocialur pirovnul aSlilobas.

ICD-10mniSvnelovnad cdeba mocemuli asakis bavSvisaTvis da-maxasiaTebeli normaluri qcevis farglebs imave socia-lur-kulturul konteqstSi.

aRniSnuli darRvevebi ar aRwevs sxvebis uflebebis uxe-Sad da seriozulad darRvevis xarisxs. aseTi aSlilobis mqone bavSvebs xSirad tendencia aqvT ar daemorCilon ufrosebis moTxovnebsa da wesebs, gamiznulad moabe-zron Tavi sxvebs. xSirad brazebian, advilad Rizian-debian, aRSfoTdebian; advilad wyinT, sxvebs abraleben sakuTar Secdomebsa da sirTuleebs.

maT dabali frustraciis done aqvT da swrafad gamo-dian wyobidan.

Cveulebriv, maTi daumorCilebloba ufro provokaciul xasiaTs atarebs; isini konfrontacias iwyeben, gadamete-bul uxeSobas amJRavneben, ar SeuZliaT TanamSromloba da ewinaaRmdegebian avtoritets.

xSirad es qcevebi gamokveTilad iCens Tavs kargad nac-nob ufrosebTan an tolebTan urTierTobisas. amitom aSlilobis niSnebi SeiZleba ar gamovlindes klinikuri intervius dros.

qcevis sxva aSlilobebisagan ZiriTadi gansxvaveba mdgo-mareobs imaSi, rom am dros ar gvxvdeba iseTi qcevebi, romlebic sxvebs seriozulad avnebs _ sisastike, qur-doba, Tavdasxma, gaupatiureba.

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•

•

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•

•

�86

CBCagresiuli qceva(�-3 wlis):

• daumorCilebeli;

• momTxovni;

• gaugonari;

• iolad frustrirdeba;

• eWviani;

• egoisti;

• moCxubari;

• urtyams sxvebs;

• advilad brazdeba;

• ar reagirebs dasjaze;

• kivis;

• egoistia;

• uguneboba;

• feTqebadia;

• myvirala;

• zluquna.

destruqciuli qceva(�-3 wlis):

• ar SeuZlia koncentracia;

• ReWavs arasakveb nivTierebebs;

• sastikia cxovelebis mimarT;

• amtvrevs sakuTar saTamaSoebs;

• Wams arasakveb nivTierebebs;

• SemTxveviT azianebs sakuTar Tavs da sxvebs;

• arwevs sxeuls da Tavs aqicinebs;

• swrafad gadadis erTi aqtivobidan meoreze;

agresiuli qceva (4-�8 weli):

• Sepasuxeba;

• trabaxi;

• iTxovs yuradRebas;

�87

• sisaZagleebs Cadis sxvebis mimarT;

• amtvrevs da afuWebs sakuTar nivTebs;

• afuWebs sxvebis nivTebs;

• urCobs skolaSi;

• urCobs saxlSi;

• eWviania;

• Cxubobs;

• Tavs esxmis;

• kivis;

• Tavs iwonebs;

• ecvleba guneba-ganwyoba;

• jiutia;

• bevrs laparakobs;

• xmauriania;

• isterika (braziani sijiute).

delikventuri (samarTaldamrRvevi) qceva (4-�8 weli):

• danaSaulis gancdis nakleboba;

• cruobs da TvalTmaqcobs;

• garbis;

• upiratesobas aniWebs ufrosebs;

• xanZars aCens;

• saxlidan iparavs;

• Zalian bevrs fiqrobs seqsze;

• acdens skolas;

• iyenebs alkohols da wamlebs;

• axasiaTebs vandalizmi.

�88

qceviTi aSlilobis diagnostikuri kriteriumebi DSM-IV-TR, ICD-10 da CBC-is mixedviT

DSM-IV-TRa. iseTi qcevebi, romlebic mudmvivad uxeSad arRvevs

sxvebis uflebebs, an asakisaTvis Sesaferis socialur normebs da wesebs.ukanaskneli �� Tvis ganmavlobaSi unda gamovlindes qve-

moT CamoTvlili kriteriumebidan minimum 3 mainc; � krite-riumi mainc unda vlindebodes ukanaskneli 6 Tvis ganmav-lobaSi.

• agresia adamianebis da cxovelebis mimarT:a) xSirad Seuracxyofs, aSinebs da emuqreba sxvebs;b) xSirad iwyebs fizikur Cxubs;g) iyenebs xolme iaraRs;d) fizikurad sastikia adamianebis mimarT;e) fizikurad sastikia cxovelebis mimarT;v) iparavs msxverplTan konfrontaciis SemTxvevaSi;z) sxvas aiZulebs seqsualur aqtivobas.

• sakuTrebis destruqcia:a) SemCneulia ganzrax cecxlis mokidebaSi;b) winaswari ganzraxviT afuWebs sxvebis sakuTrebas.

• TaRliToba da qurdoba:a) texavs sxvis binas, manqanas, Senobas;b) xSirad ityueba sasurveli nivTis an keTilganwyobis

miRebis mizniT da Tavs aridebs valdebulebebs;g) iparavs nivTebs msxverplTan konfrontaciis gareSe;

• wesebis seriozuli darRveva:a) saxlSi gvian Ramemde ar modis, miuxedavd mSoblebis

akrZalvisa (�3 wlamde);b) saxlidan garbis mTeli RamiT, erTxel mainc ar

brundeba xangrZlivi periodis ganmavlobaSi;g) xSirad acdens skolas �3 wlamde.

b. qceviTi aSliloba iwvevs klinikurad mniSvnelovan dar-Rvevebs socialur, akademiur da SromiT funqcionire-baSi.

g. �8 wlis Semdeg maT ver miudgeba antisocialuri pirov-

�89

nebis aSlilobis kriteriumi. specialurad aRsaniSnia dawyebis periodi: 3��.8� bavSvobis asakSi (�0 wlamde), 3��.8� mozardobis asakSi.3��.89 dawyebis asaki dauzustebelia

specialurad aRsaniSnia darRvevis simZime:ioli, saSualo, mZime.

ICD-10qceviTi aSliloba xasiaTdeba asocialuri, agresiuli

da daumorCilebeli qcevis ganmeorebadi da mdgradi pater-niT.

aseTi qcevebi iwvevs asakisaTvis Sesaferisi socialuri molodinebis darRvevas da ufro mavnea, vidre bavSvuri ma-vneoba, an saymawvilo amboxi.

qcevis saxeebi, romelTa safuZvelzec diagnozi ismeba, Semdegs moicavs:

sxvebis Seuracxyofis da Cxubis gansakuTrebiT maRali xarisxi;

sisastike adamianebisa da cxovelebis mimarT; sakuTre-bis mZime dazianeba; cecxlis mokideba; qurdoba; xSiri si-crue;

skolis gacdena da saxlidan gaqceva; uCveulod xSiri da mZime isterikebi; daumorCilebeli, provokaciuli qceva, mudmivi da Zlieri urCoba.

Tu nebismieri es kategoria mniSvnelovnad aris gamoxa-tuli, sakmarisia diagnozisaTvis; amave dros, mxolod izo-lirebuli disocialuri aqtivoba ar aris sakmarisi.

gamoricxvis kriteriumi Seicavs iseT mdgomareobebs, rogoricaa Sizofrenia, depresia, hiperkinetikuri darRve-va.

diagnozi ismeba, Tu darRveuli qcevis gamovlinebis xangrZlivoba 6 Tveze metia.

specialurad aRsaniSnia:qcevis darRveva Semoifargleba ojaxuri konteqstiT,

rodesac simptomebi mxolod saxlSi vlindeba;arasocializebuli qcevis darRveva _ tolebTan ur-

�90

TierTobis mudmivi anomaluroba;socializebuli qcevis darRveva, rodesac individi kar-

gad aris integrirebuli Tanatolebis jgufSi.

aucilebelia diferencialuri diagnozi gakeTdes:

yuradRebis deficitisa da hiperaqtivobis sindromTan;

qceviT aSlilobasa da opoziciur-deviantur qceviT aS-lilobas Soris;

bavSvobisa da mozardobis asakis guneba-ganwyobis aSli-lobasTan;

Seguebis aSlilobebTan;

bavSvobis fsiqotur aSlilobebTan.

ra aris qceviTi aSlilobis mizezi?

qceviT aSlilobebs gansxvavebuli TeoriebiT, sxva-dasxvagvari interpretaciiT xsnian; Sesabamisad mkurnalo-bis gansxvavebul principebs gvTavazoben.

biologiuri Teoriebi

genetikuri (Plomin,1991):

agresiis mimarT predispozicia memkvidreobiTi xasiaTi-saa; konstituciuri faqtori mniSvnelovan rols asrulebs qceviTi aSlilobis aRmocenebaSi. statistikurad, popula-ciaSi, qalebTan SedarebiT, mamakacebs ufro xSirad aRe-niSnebaT qcevis darRvevebi; monozigotur tyupebSi qcevis darRvevis Tanxvedris sixSire mniSvnelovnad maRalia, vi-dre dizigoturSi.

bolo periodamde agresiuli qceva zedmeti Y qromoso-mis arsebobas miewereboda, rac ukanaskneli gamokvlevebiT ar dadasturda(Bolton, Holland, 1994).

�9�

hormonuli (Dabbs, 1991):

mamakacebSi agresiul qcevas gansazRvravs testostero-nis donis zrda.

agznebis Teoria (Raine,1988; Kazdin,1995):

qceviTi aSlilobis mqone bavSvs gaaCnia prosocialuri qcevis daswavlis, an antisocialuri qcevis acilebis una-ris darRveva. memkvidreobiT miRebuli agznebis, normasTan SedarebiT dabali done maT naklebad mgrZnobiares xdis da-debiTi da uaryofiTi ganmtkicebisadmi. Sesabamisad, aseT bavSvs socialuri wesebis aTvisebisa da daswavlisaTvis esa-Wiroeba Zlier struqturirebuli garemo.

neirofsiqologiuri deficitis Teoria (Moffat, 1993):

verbaluri gansjisa da moqmedebis dagegmvis neirofsi-qologiuri deficiti safuZvlad udevs TviTregulaciis siZneleebs. es iwvevs saskolo moswrebis daqveiTebas, rac, Tavis mxriv, frustraciis mizezsa da agresiuli qcevis ga-momwvev faqtors warmoadgens.

fsiqodinamikuri Teoriebi

super-egos deficitis Teoria (Aichorn,1935):antisocialuri qcevis provocirebas axdenen abuCad amg-

debi, ugulebelmyofeli an yovladSemwynarebeli mSoble-bi. pirvel SemTxvevaSi mSoblebTan urTierTobisas bavSvis mier xdeba mSoblebis agresiis stilis gaSinagneba; meore Se-mTxvevaSi ki bavSvi meryev da sust standartebs iTvisebs.

mijaWvulobis Teoria (Bawlby, 1944):bavSvebs, romlebic sicocxlis pirvel TveebSi garkveu-

li periodiT Sordebian mSoblebs, SemdgomSi naklebad uvi-TardebaT usafrTxo mijaWvuloba. mogvianebiT periodSi maT ar gaaCniaT cxovrebiseuli Sinagani zneobrivi modele-bi socialuri urTierTobebis warsamarTavad.

�9�

qceviTi aSlilobis mqone bavSvebi mtrul ganwyobas sxve-bs miaweren da samagiero agresiiT pasuxoben. Tanatolebis reaqcia ganamtkicebs mtrul atribuciul stils. bavSvebs ara aqvT socialuri problemebis alternatiuli gadawyve-tisa da ganxorcielebis Cvevebi, amitom, isini agresias iye-neben.

kognituri Teoriebi

socialuri informaciis gadamuSavebis Teoria (Crick, Dodge, 1994):

agresia daiswavleba mibaZvis procesSi an mSoblebisa da ufrosi da-Zmis qcevis modelirebis procesSi.

socialuri Cvevebis deficitis Teoria:qceviTi aSlilobis mqone bavSvebi antisocialur qcevas

swavloben mSoblebTan urTierTobisas, romelsac Zalado-brivi xasiaTi aqvs.

socialuri daswavlis Teoriebi

modelirebis Teoria (Bandura, Walters, 1959):qcevis problema aRmocendeba dezorganizebul ojaxSi, ro-melsac aklia:

• problemis gadawyvetis da komunikaciuri Cvevebi;

• mkafio wesebi, rolebi da yoveldRiuri ojaxuri cxovre-bis wesebi;

• mkafio sazRvrebi da ierarqia;

• cxovrebis ciklis gardamavali periodebis moqnili daZ-leva.

Zaladobrivi ojaxuri urTierTobis Teoria (Patterson, 1992):

socialurad araxelsayreli, delikventuri subkultu-ris SigniT qurdoba da sxva antisocialuri qcevebi arale-gitimuri saSualebebia mocemuli kulturisaTvis mniSvne-lovani materialuri miznebis misaRwevad. aseT subkultu-

�93

raSi bavSvs Zaladobrivi da delikventuri qcevis strate-giebisadmi mimReblobis didi albaToba aqvs.

qceviTi aSlilobis aRmocenebis risk-faqtorebi:• rTuli temperamenti• vegetatiuri nervuli sistemis daqveiTebuli reagireba• mSoblebis uTanxmoeba• siRaribe• uxeSi, sastiki da araTanmimdevruli aRzrdis stili.

zogierTi kvlevis mixedviT qceviT aSlilobebTan maRal korelaciaSia 3 risk-faqtori: sastiki mopyroba da araTan-mimdevruli aRzrda, dabali akademiuri moswreba da mSo-blebis uTanxmoeba (Wadell et al., 1999).

mravali kvleva adasturebs, rom qceviTi aSliloba mra-vali socialuri da biologiuri faqtoris erToblivi ze-moqmedebis Sedegia (Wadell et al., 1999). qceviTi aSlilobis SenarCuneba xdeba:

• individualuri faqtorebiT (mtruli atribuciuli stili, mwiri socialuri Cvevebi, prosocialuri qcevis daswavlis gaZneleba);

• ojaxuri faqtorebiT (mSobeli-bavSvis mijaWvulobisa da disciplinis problemebi, col-qmruli uTanxmoeba da ojaxuri dezorganizacia);

• skolis faqtorebiT;

• sazogadoebrivi faqtorebiT.

rogoria daxmareba qceviTi aSlilobis SemTxvevaSi?

radganac qceviTi aSliloba sxvadasxva risk-faqtorebis urTierTqmedebis Sedegia, mkurnalobis strategiebi Sei-Zleba moicavdes sxvadasxva dones: individualurs, mSo-blebs, ojaxurs da sazogadoebrivs. qceviTi aSlilobis mkurnalobaSi yvelaze efeqturad iTvleba Semdegi saxis in-tervenciebi:kognituri problemis gadaWris Cvevebis treningi _ im-

�94

pulsururobisa da negatiuri atribuciis efeqturi da-Zleva;

mSoblebisaTvis marTvis treningi _ aRzrdis Tanmim-devruloba, Svilebze Zaladobis Semcireba, ojaxis wevrebs Soris komunikaciisa da gaziarebis gaZliereba;

funqcionaluri ojaxis Terapia _ sistemuri midgomisa da kognituri da qceviTi modifikaciebis kombinacia ojaxis komunikaciis da mxardamWeri funqciis gaumjobe-sebis mizniT;

multisistemuri Terapia _ ojaxze centrirebuli mkurnaloba, romelic sxvadsxva sistemebs moicavs: ojaxs, skolas, sazogadoebas – mSoblebisa da Svilebis prosocialuri qcevis gaumjobesebis mizniT (Kazdin, 1995).qceviTi aSlilobis qronikulobisa da simZimis gaTval-

siwinebiT, specialistebis umetesobas efeqturad miaCnia ramdenime intervenciis kombinacia da xangrZlivi meTvaly-ureoba.

mravali gamokvlevisa da specialistis mixedviT, Semde-gi intervenciebi da RonisZiebebi uefeqtod da absolutu-rad uSedegod iTvleba:medikamenturi mkurnaloba (Earls, 1994; Kazdin, 1995)

garda im SemTxvevebisa, sadac yuradRebis deficitisa da hiperaqtivobis sindromia komorbiduli;

mkacrad damsjeli RonisZiebebi, rogoricaa Tavisu-flebis xangrZlivi aRkveTa, koreqciuli banakebi, nu-lovani tolerantobis politika (Kazdin, 1995; Werry, 1997; AACAP, 1997). aRniSnuli RonisZiebebi kidev ufro mZime Sedegebs iZlevian (Kazdin, 1995; AACAP, 1997; Rut-ter, 1999). delikventuri bavSvebisa da mozardebis erTad izolacia da maT mimarT mxolod damsjeli RonisZie-bebis gamoyeneba, sxva alternatiuli qcevebis SeTavaze-bis gareSe, kidev ufro aZlierebs deviantur qcevas da agresias (Connor, 2002);

individualuri fsiqodinamikuri fsiqoTerapia (Kazdin, 1995; AACAP, 1997).

bevrad ufro efeqturia qceviTi aSlilobis preven-

�95

ciuli RonisZiebebi da prevenciis politika pirvel rigSi imitom, rom mkurnloba Zviria da mxolod mcire jgufebs moicavs.

prevenciis programebi SeiZleba iyos:universaluri _ yvela baSvisa da mozardisTvis, Tu maTi

ojaxebisTvis;miznobrivi _ mxolod risk-jgufebisaTvis.

mkvlevrebma da specialistebma gamoyves qceviTi aSli-lobebis efeqturi prevenciis Semdegi programebi:skolamdeli asakis bavSvebis ganmaviTrebeli programebi

sabavSvo baRebSi;saskolo programebi _ mSoblebisa da maswavleblebis

treningi, maswavleblis xSiri komunikacia mSobelTan, mravalferovani saklaso samuSao da saskolo RonisZie-bebi;

sazogadoebrivi programebi _ mSoblebis treningi, rekreaciuli programebi, avtoritetuli ufrosebis mier mozardebis mentoroba (Kazdin, 1995; Waddell et al., 1999).bavSvisa da mozardis qceviTi aSlilobebis adekvaturi

Sefasebisa da daxmarebisaTvis metad mniSvnelovania:Terapiuli aliansis damyareba bavSvsa da mis ojaxTan;kulturuli faqtorebis gaTvaliswineba Sefasebisas;qceviTi aSlilobebis Sesafaseblad aucilebelia in-

formaciis miReba uSualod bavSvisgan da mSoblebisgan;mkurnalobis efeqturobisaTvis aucilebelia sxva mdgo-

mareobebTan qceviTi aSlilobis komorbidulobis dad-gena;

sasargebloa bavSvebis da mozardebis qcevis Sesafasebe-li kiTxvarebis da skalebis gamoyeneba maTi mdgomare-obis perioduli monitoringis mizniT. es SeiZleba iyos aSenbaxis kiTxvarebi mSoblisa da maswavleblisTvis;

individualuri mkurnalobis gegmis Sedgena konkretu-li SemTxvevis specifikidan gamomdinare da moklevadia-ni miznebis dasaxva;

mSoblebis fsiqoganaTleba da qcevis marTvis treningi;farmakologiuri Terapia SesaZlebelia, rogorc Tanmx-

�96

lebi ZiriTadi intervenciis programisa, gansakuTrebiT komorbiduli mdgomareobebis dros;

intervenciis programebi unda iyos xangrZlivi da in-tensiuri; efeqturia, Tu isini erTdroulad moicaven ojaxsa da skolas.

amrigad, qceviTi aSlilobis da opoziciur-devianturi qceviTi aSlilobis mqone bavSvebisa da mozardebis yvelaze efeqturi daxmarebaa risk- jgufebisTvis prevenciuli Ro-nisZiebebis ganxorcieleba, aseve, sistemuri intervencia, romelic moicavs ojaxis wevrebisa da skolis fsiqologiur daxmarebas. sazogadoebrivi programebi da sabavSvo baReb-Si dawyebuli aRmzrdelobiT-ganmaviTarebeli RonisZiebebi mniSvnelovnad amcirebs delikventuri qcevis risks.

�97

qromosomuli daavadebebi

qromosomuli sindromi klinikuri mdgomareobaa, rome-lic ganpirobebulia qromosomebis raodenobisa da stru-qturis darRveviT. am dros adgili aqvs ama Tu im qromo-somaSi lokalizebuli genetikuri substratis siWarbes an naklebobas.

qromosoma. ujredis birTvi Seicavs qromatins, romlis-ganac birTvis gayofis procesSi warmoiqmneba qromosomebi. `qromosoma~ niSnavs `SeRebil sxeuls~. qromosoma Txeli, Zafisebri formisaa da SeimCneva mxolod specialuri saRe-baviT SeRebili ujredis gayofisas. qromosomaSi SeimCneva mokle da grZeli mxari, SuaSi _ Seviwroeba. qromosoma Sed-geba dezoqsiribonukleinis mJavasgan (dnm). is Seicavs zust memkvidreobiT informacias da Taobidan Taobas gadaecema. adamianis ujredSi 46 qromosomaa. �� wyvili _ somaturi, arasasqeso qromosomaa, romelTac autosomebs uwodeben; �3-e wyvilSi ki orive sqesobrivi qromosomaa: mdedrobi-Ti sqesis genetikuri qromosomuli kompleqsia XX, xolo mamrobiTis _ XY. es aris adamianis normaluri kariotipi (nimuSi).

geni _ memkvidreobiTi niSnebis gadatanis ZiriTadi er-Teulia. genebi qromosomis Semadgeneli nawilebia, romelTa masalas dezoqsiribonukleinis mJava (dnm) warmoadgens. yo-vel qromosomaSi dnm-is erTi grZeli, Txeli, ormagi spira-lis mqone molekulaa da genebi am molekulis nawilebs war-moadgens. dnm-is jaWvi nukleotidebisagan Sedgeba, amitom yoveli genis safuZvels sxvadasxva nukleotidis (citozini, guanini, adenini, Timini) Tanmimdevroba Seadgens. maTi Tanmi-mdevroba genis Tvisebebs gansazRvravs. genebi Tavis gavle-nas nukleotidebis mier warmoebuli molekulebiT axorcie-lebs. genis erT-erTi produqtia ribonukleinis mJava (rnm), romelic dnm-is monakveTis odnav saxecvlili aslia. rnm-is molekulebi did rols TamaSobs organizmis metabolizmSi, maTi umetesoba ki cilebis safuZvels warmoadgens. cilebi Sedgeba e.w. amonomJavebis jaWvisagan. cilaSi aminomJavebis ganlagebis Tanmimdevrobas rnm-Si nukleotidebis Tanmim-devroba gansazRvravs genetikuri kodis meSveobiT. cilaSi

�98

aminomJavebis Tanmimdevroba, Tavis mxriv, gansazRvravs ci-lis daniSnulebas: igi organizmis struqturis nawili unda gaxdes, Tu enzimi, anu organizmSi qimiuri reaqciebis xel-Semwyobi substrati (fermenti). aqedan gamomdinare, dnm-is cvlilebam, SeiZleba, gamoiwvios organizmis struqturis an qimiuri Semadgenlobis cvlileba.

qromosomuli sindromebi Tandayolili simptomokom-pleqsebia, romlebic qromosomuli aberaciebis (gadaxris) Sedegad viTardeba. qromosomuli aberaciebi, SeiZleba, sxvadasxva saxis iyos.

qromosomis tipis mixedviT:

• autosomebis dazianeba, an raodenobis cvlileba;

• sqesobrivi qromosomebis dazianeba, an raodenobis cv-lileba.

qromosomebis raodenobis mixedviT:

• romelime qromosomis trisomia, rodesac kariotipi Sei-cavs erT zedmet qromosomas;

• monosomia, rodesac erTi qromosoma dakargulia.

qromosomebis struqturis cvlilebis mixedviT:

• delicia _ qromosomuli masalis nawilis dakargva;

• duplikacia _ qromosomis nawilis gaormageba;

• translokacia _ mTliani qromosomis, an misi nawilis sxva qromosomaze gadatana;

• mozaicizmi _ qromosomebis nawili dazianebulia, nawili ki _ ara;

• meTilacia _ dnm-is struqturis qimiuri cvlileba, rac cvlis mis aqtivobas.

axaldabadebul bavSvebSi yvelaze xSiria Semdegi qromo-somuli aberaciebi:��-e qromosomis trisomia, daunis sindromi;me-�8 qromosomis trisomia, edvardsis sindromi;

�99

me-�3 qromosomis trisomia, pataus sindromi;X trisomia, XXX sindromi;ormagi Y sindromi, XYY;XXY, klainfelteris sindromi;XO , terneris sindromi.

autosomebis aberacia klinikurad vlindeba, ZiriTadad, fsiqikuri ganviTarebis Zlier CamorCenaSi, ganviTarebis Tandyolil anomaliebsa da mankebSi.

sqesobrivi qromosomebis aberacia ar iwvevs fsiqikuri ganviTarebis mZime CamorCenas, Tumca, mJRavndeba ganviTa-rebis Taviseburebebsa da sxvadasxva saxis deficitSi.

zogierT qromosomul anomalias memkvidreobiTi xasia-Ti aqvs, anu defeqturi qromosomisa da genetikuri masalis matarebeli erT-erTi mSobelia. bavSvSi, memkvidreobiTo-bis kanonzomierebidan gamomdinare, SeiZleba, gamovlindes qromosomuli sindromi.

zogierT qromosomul aberacias ara aqvs memkvidreobi-Ti xasiaTi da misi warmoSobis mizezebi sakmaod bundovania. Tumca, gamokvlevebidan cnobilia, rom qromosomebis Se-madgenlobasa da ujredebis normalur dayofaze garkveul gavlenas axdens garemos faqtorebi: radiacia, garemos da-binZureba qimikatebiT, toqsinebiT, sakvebis xelovnuri da-namatebi da a.S.

300

daunis sindromi

ra aris daunis sindromi?daunis sindromi aris qromosomuli daavadeba, romlis

drosac adamians, 46 qromosomis nacvlad, 47 qromosoma aqvs; rogorc wesi, ��-e qromosomaze wyvilis magivrad aris 3 qromosoma. amitom, mas sxvanairad ��-e wyvilis trisomi-asac uwodeben. zedmeti qromosomuli masala iwvevs daunis sindromisaTvis damaxasiaTebel fizikur da fsiqikur Tvi-sebebs. es daavadeba pirvelad aRwera ingliselma eqimma J. Down-ma me-�9 saukunis bolos, ris gamoc, daavadebas daunis sindromi ewoda. �959 wels ki frangma eqimma Lejan-ma daunis sindromi gansazRvra rogorc qromosomuli anomalia. man aRmoaCina, rom daunis sindromis mqone adamians TviToeul ujredSi, 46 qromosomis nacvlad, 47 qromosoma aqvs.

ra axasiaTebs daunis sindroms? arsebobs daunis sindromisaTvis damaxasiaTebeli fizi-

kuri niSnebi; am sindromis mqone bavSvebSi, zogjer, TiTqmis yvela maTgani vlindeba, zogjer ki mxolod ramdenime niSa-ni. yvelaze gavrcelebuli niSnebia:

• kunTTa dabali tonusi _ hipotonia;

• saxis brtyeli profili;

• cxviris farTo, CaRrmavebuli xidi, patara cxviri;

• Tvalis iribi Wrili;

• deformirebuli yurebi;

• mokle, farTo xelebi, xelis gulze erTi Rrma Rari;

• me-5 TiTze oris nacvlad erTi mosaxreli saxsari;

• didi daSoreba fexis did da meore TiTs Soris;

• piris patara zoma;

• piris zomasTan SedarebiT didi ena;

• ganieri terfi patara TiTebiT;

• mokle kiseri;

• patara Tavi;

• epikantusi _ Tvalebis Sida kuTxeSi kanis patara naoWi.

30�

daunis sindromis mqone bavSvebSi xSiria:

• gulis Tandayolili manki;

• saWmlis gadamuSavebis problemebi;

• bavSvobis periodis leikemia;

• mxedvelobisa da smenis darRvevebi;

dReisaTvis janmrTelobis aRniSnuli problemebis umetesoba gankurnebadia, xolo daunis sindromis mqone adamianTa sicocxlis xangrZlivoba gazrdilia da saSua-lod 55 wels Seadgens.

daunis sindromisaTvis damaxasiaTebelia sxvadasxva xarisxis gonebrivi CamorCeniloba. aseTi bavSvebi gvian swav-loben jdomas, siaruls, laparaks, TamaSs, sayofacxovrebo, yoveldRiur Cvevebs. amasTan, isini zedmetad mgrZnobiareni arian fizikuri da socialuri garemosadmi. maTi wyenineba Zalian advilad SeiZleba. amave dros, isini swrafad re-agireben megobrul da mSvid damokidebulebaze, uyvarT sxva adamianebTan urTierToba, siaxle, arian cnobismoyvareni.

daunis sindromis mqone bavSvebi skolaSi masalas nela swavloben da nela iTviseben Cvevebs, magram Zalian mondo-mebulni arian; swavlebisa da aRzrdis procesSi maTi waxa-liseba metad efeqturia.

daunis sindromis mqone bavSvebis didi garegnuli msgavsebis miuxedavad, yvela maTgani erTmaneTisagan gan-sxvavebulia. iseve rogorc sxva bavSvebs, maTac gansxvave-buli unar-SesaZleblobebi da niWi gaaCniaT; umetesobas ioli da saSualo xarisxis gonebrivi CamorCeniloba aqvs, daavadebulTa mcire procentSi aRiniSneba Zlier gamoxat-uli gonebrivi CamorCeniloba.

unda aRiniSnos, rom gonebrivi CamorCenilobis xarisxi da IQ maCvenebeli ar aris sakmarisi daunis sindromis mqone bavSvis Sesacnobad, radgan yovel konkretul bavSvs saku-Tari unikaluri SesaZleblobebi _ Zlieri da susti mxa-reebi aqvs.

ra aris daunis sindromis mizezi?daunis sindromis mizezs warmoadgens mSoblebis sasqeso

ujredebis gayofis procesSi warmoSobili darRvevebi. ase-

30�

Ti darRvevebis gamo, nayofis ujredebSi ��-e qromosomaze wyvilis magivrad 3 qromosoma aRmoCndeba. aRniSnuli dar-Rvevebi, ZiriTadad, sami saxisaa: • daucilebloba – yvelaze xSiri darRvevaa; am SemTx-

vevaSi dedis an mamis sasqeso ujredis gayofisas (mei-ozi) ar xdeba ��-e wyvili qromosomis gancalkeveba da ganayofierebis Semdeg trisomiuli zigota iqmneba.

• mozaicizmi – gvxvdeba daunis sindromis mqone pirTa �-�%-Si. am dros ��-e qromosomis daSoreba ar xdeba ga-nayofierebis Semdeg, embrionis ujredis gayofis pro-cesSi. am dros Cndeba ujredebis ori tipi: zogis bir-Tvi Seicavs 46 qromosomas, zogis ki _ 47 qromosomas;

• translokacia _ vlindeba daunis sindromis mqone pirTa 3-4%-Si. am dros ujredis dayofis procesSi ��-e qromo-soma mowydeba da miemagreba sxva qromosomas. ujredebSi qromosomaTa raodenoba isev 46-ia, magram ��-e qromoso-mis damatebiTi nawili iwvevs daunis sindroms. miiReba e.w. arabalansirebuli kariotipi.qromosomaTa daucileblobis mizezebi sabolood ar

aris garkveuli, magram xSirad asaxeleben: dedis asaks, garemos dabinZurebis faqtorebs.

pirveli bavSvis daunis sindromiT dabadebisas momdevno bavSvSi am sindromis ganviTarebis riskia � : �00. 35 wel-ze meti asakis qalebSi sagrZnoblad matulobs daunis sin-dromis mqone bavSvis dabadebis albaToba. Tumca, zogadad, daunis sindromis mqone bavSvebis dedaTa umravlesoba 35 welze naklebi asakisaa.

ramdenad xSiria daunis sindromi?axalSobilebSi daunis sindromi yvelaze gavrcelebuli

qromosomuli daavadebaa. yoveli 800-�000 axalSobilidan � ibadeba am sindromiT; mamakacebsa da qalebSi erTnairi sixSiriTaa gavrcelebuli.

ra ZiriTadi problemebia daunis sindromis dros?• pirvel rigSi, yuradReba unda mieqces bavSvis fizikur

janmrTelobas. daunis sindromis mqone bavSvebs, SeiZ-leba, dabadebis Semdeg SeeqmnaT sxvadasxva samedicino

303

problema met-naklebi xarisxiT.• daunis sindromis mqone bavSvebis 50%-Si gvxvdeba gu-

lis Tandayolili manki. amitom, aucilebelia, adreuli diagnostika da saWiroebis SemTxvevaSi _ qirurgiuli mkurnaloba.

• leikemiis riski daunis sindromis mqone bavSvebSi �5-�0-jer metia, vidre normalur populaciaSi. igi sicocxlis pirveli 3 wlis manZilze vlindeba da misi gankurnebis albaToba sakmaod maRalia.

• xSiria sxvadasxva xarisxis mxedvelobisa da smenis darR-vevebi. maTi adreul asakSi diagnostireba metad mniSv-nelovania, radganac fsiqikuri ganviTarebis CamorCenis SemTxvevaSi, mxedvelobiTi, Tu smeniTi sensoruli defi-citis gauTvaliswinebloba amcirebs swavlebis efeqtu-robas; Sesabamisad, aucilebelia medikamenturi mkurna-loba, teqnikuri daxmareba da swavlebis gansxvavebuli strategiebi.

• simsuqnisadmi midrekileba saWiroebs dietologis dax-marebas, balansirebul, dabalkaloriul dietas.

• aseve xSiria metyvelebis problemebi da metyvelebis ganviTarebis Seferxeba.

daunis sindromis mqone bavSvis metyveleba mouqneli da naklebad mkafioa. sqeli, didi enis, maRali sasis, kbilebis defeqtebis, xmis iogebis, saxis kunTebis maRali tonusis, xSirad, daqveiTebuli smenis gamo maTi metyveleba: artiku-lacia, gamoTqma, intonaciuri mxare, xmis modulacia, xmis toni, specifikuri xasiaTisaa.• sensomotorul ganviTarebaSi CamorCena gamoxatulia

motoruli Cvevebis aTvisebis, TviTmomsaxurebis Cveve-bis gamomuSavebis sirTuleSi da droSi gaxangrZlive-biT. amave dros, gaZnelebulia sensoruli informaciis aqtiuri gadamuSaveba, gvian yalibdeba warmodgenebi `sagnebis mudmivobis~ Sesaxeb, bavSvebs uWirT sagnebis sensoruli Tvisebebis garCeva (feris, formis, zomis, faqturis) da Semdeg ganzogadeba.

• azrovnebis ganviTarebis Tavisebureba gamoixateba imaSi, rom daunis sindromis mqone bavSvebi ganzogade-bas axdenen TvalsaCino Tvisebebis safuZvelze, uad-

304

vildebaT TvalsaCino analogiebis gageba. bavSvebs aqvT drois, sivrcis, Tanmimdevrobis mimarTebis aRmniSvneli konstruqciebis gagebis problemebi, miRebuli gamocdi-lebis sxva situaciaSi gamoyenebis siZnele.

SeiZleba Tu ara daunis sindromis mqone bavSvebis daxmareba?

dReisaTvis mravalgvari saSualeba arsebobs daunis sin-dromis mqone bavSvebis dasaxmareblad:• gul-sisxlZarRvTa daavadebebis, mankebis efeqturi Te-

rapiuli Tu qirurgiuli mkurnaloba;• adekvaturi balansirebuli kvebis dieta naklebi cxime-

biTa da naxSirwylebiT;• smenisa da mxedvelobis darRvevebis mkurnaloba: teqni-

kuri mowyobilobis gamoyeneba, qirurgiuli mkurnalo-ba;

• bavSvis SesaZleblobebis fsiqologiuri Sefaseba da misi swavlebisaTvis adekvaturi strategiis SemuSavba;

• metyvelebis Terapia;• okupaciuri da fizikuri Terapia;• adreuli asakis intervenciis programebi, rac niSnavs

adreuli asakidan bavSvis sensoruli da motoruli gan-viTarebis stimulirebas, specialuri pirobebis Seqmnas bavSvis SemecnebiTi aqtivobisaTvis.

gankurnebadia Tu ara daunis sindromi?ara, dReisaTvis igi ar ikurneba. Tumca, Zalze efeq-

turia simptomaturi medikamenturi mkurnaloba, aqtiuri pedagogiur-fsiqologiuri programebi, adreuli interven-ciis programebi.

ra momavali aqvs daunis simdromis mqone bavSvs? garkveuli saerTo damaxasiaTebeli niSnebis miuxedavad,

daunis sindromis mqone bavSvebi Zlier gansxvavdebian erT-maneTisagan xasiaTiT, temperamentiT, unar-SesaZleblobe-biT, inteleqtis doniT, niWiT. amitom isini individualur midgomas saWiroeben. zogierT bavSvs SeuZlia zogadsaganma-naTleblo skolaSi swavla, zogisaTvis specialuri klasia

305

saWiro, zogierTisaTvis ki _ specialuri skola. mozarde-bis umravlesobas SeuZlia daeuflos raime profesias an xelobas sakuTari interesebisa da niWebis Sesabamisad. zo-gierTs didi dro da specialuri momzadeba sWirdeba mar-tivi operaciebis asaTviseblad, zogierTi ki rTul saqmia-nobas eufleba specialuri treningis saSualebiT. xelobis aTvisebac individualuri procesia. mTavari is aris, rom adekvaturi midgomis SemTxvevaSi, bavSvis SesaZleblobe-bisa da xasiaTis gaTvaliswinebiT, daunis sindromis mqone ukve mozrdil pirovnebas SeuZlia konkretuli samuSaos Sesruleba. mas moswons sazogadoebriv urTierTobebSi aq-tiuri monawileobis miReba, didi pasuxismgeblobiT ekideba samuSaos da gulmodgined asrulebs mas. zogierTi damou-kideblad muSaobs, zogierTs ki samuSaos Sesasruleblad zedamxedveli esaWiroeba.

306

viliamsis sindromi

ra aris viliamsis sindromi?viliamsis sindromi genetikuri daavadebaa, romelsac

Tan axlavs damaxasiaTebeli fizikuri niSnebi, fsiqikuri ganviTarebis Seferxeba, daswavlis unaris darRveva da yur-adRebis deficiti.

ra axasiaTebs viliamsis sindroms?qvemoT aRwerili fizikuri da fsiqologiuri maxasiaTe-

blebi im potenciur sferoebs moicavs, romlebSic SeiZleba bavSvs problema hqondes. es ar niSnavs imas, rom yvela bav-Svs erTnairad gamouvlindeba qvemoT CamoTvlili Tvise-bebi. zogierT bavSvs, SeiZleba, damaxasiaTebeli niSnebis minimumi hqondes, zogierTs ki es Tvisebebi mkveTrad hqon-des gamoxatuli.

viliamsis sindromis mqone bavSvisaTvis sindromi mxo-lod erTi faqtoria, romelic mis zrda-ganviTarebaze ax-dens gavlenas; magram, mniSvnelovania, garemo faqtorebic _ ojaxis roli, saswavlo garemo, romlebic aranakleb zemoq-medebas axdens bavSvis ganviTarebaze.

fizikuri maxasiaTeblebi:• damaxasiaTebeli saxis nakvTebi: patara, maRla aweuli

cxviri, didi da msxvili tuCebi, grZeli zeda tuCi, farTo piri, momcro nikapi, SeSupeba Tvalebis garSemo (ubeebi), msxvili loyebi, momcro, meCxeri kbilebi, far-To Rimili, xSirad gansakuTrebulad Ria feris Tvale-bi. asakTan erTad es niSnebi ufro TvalsaCino xdeba.

• gul-sisxlZarRvovani problemebi: Seviwroebuli aorta an Seviwroebuli filtvis arteriebi; maTi Seviwroebis xarisxi, SeiZleba, sxvadasxva iyos.

• hiperkalcemia _ sisxlSi kalciumis moWarbeba, rac iwvevs `Zlieri tkivilis~ msgavs simptomebs da Zlier gaRizianebadobas. Cvil bavSvebSi, gansakuTrebiT 4-dan �0 Tvemde, darRveulia kalciumisa da D vitaminis me-tabolizmi.

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• dabadebisas mcire wona da misi neli tempiT mateba pirveli wlis ganmavlobaSi.

• kvebis problema Cvilobis asakSi _ rac dakavSirebulia saxis kunTebis daqveiTebul tonusTan; bavSvis zrdas-Tan erTad Wamis siZneleebi qreba.

• xSiria TirkmelebTan dakavSirebuli samedicino pro-blemebi.

• hiperakuzia _ zedmetad gaZlierebuli smena; amis gamo xmauri da xmamaRali bgerebi bavSvebs aSinebs, an maTSi usiamovno SegrZnebebs iwveven. es mdgomareoba asakis ma-tebasTan erTad umjobesdeba.

• kunTebis dabali tonusi da saerTo sisuste. asakTan er-Tad vlindeba bavSvis mouqneloba da motoruli koor-dinaciis problemebi.

fsiqologiuri maxasiaTeblebi:• Zlieri eqspresiuli metyveleba: kargi artikulacia,

frazuli metyveleba, leqsikonis maragi.• fsiqikuri ganviTarebis Seferxeba: gvian iwyeben sia-

rulsa da metyvelebas, gvian iTviseben yoveldRiur da TviTmomsaxurebis Cvevebs.

• problemebi msxvil motorikaSi (moZraobebis koordina-ciaSi, wonasworobaSi, kunTebis ZalaSi, sxeulis poze-bSi), wvril motorikaSi (Tasmebisa da Rilebis Sekvra, makratlis, danis, kalmistris, fanqris xmareba).

• problemebi sivrciTi mimarTebebis aRqmasa da cnobaSi.• yuradRebis koncentraciis sirTule, gafantuloba.• aramdgradi emociuri sfero, rac imas niSnavs, rom

sixarulisas bavSvi uaRresad igzneba, xolo wyenisas advilad tiris, aSinebs moulodneli stimulebi; aqvs midrekileba Zlieri SfoTvisadmi.

• reJimis moulodneli cvlileba an situaciis moulod-neli Secvla iwvevs bavSvis SfoTvasa da agznebas.

• sasaubro Temis amoCemeba, azris gameoreba.• TviTstimulacia kanis Cqmetis, rwevis da sxva moZraobe-

bis saxiT.• uaRresad socialuri buneba. bavSvebi advilad Sedian

kontaqtSi, ar eSiniaT ucxo pirovnebis, advilad ur-

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TierToben ufrosebTan.• bavSvebi mgrZnobiareni arian sxvisi ganwyobilebis mi-

marT; kargad igeben sxvis emociebs, urTierTobaSi mego-brulebi da gaxsnilni arian.

• aqvT kargi xangrZlivi mexsiereba.• aqvT kargi xanmokle mxedvelobiTi mexsiereba da kargi

mxedvelobiTi aRqma.• gaaCniaT SesaniSnavi musikaluri smena.

viliamsis sindromis mqone bavSvebidan zogierTs saSu-aloze maRali an saSualo monacemebi aqvs inteleqtis tes-tebis mixedviT, zogierTs ki _ mosazRvre, an saSualoze dabali. ufro xSirad gvxvdeba sxvadsxva unaris araTanaba-ri ganviTareba. magaliTad, 6 wlis bavSvs leqsikuri mara-gi, frazuli metyveleba, informaciis zogadi maragi asakis Sesaferisi, an ufro maRalic ki SeiZleba hqondes, xolo maTematikuri unarebi 3 wlis bavSvis doneze aRmoaCndes. amitom, inteleqtis testis mixedviT, inteleqtis koefici-netis gamoTvla mizanSewonili ar aris; azri ara aqvs `saSu-alos~ gamoTvlas. magaliTad, 8 wlis asakis bavSvisaTvis, romelsac Tavisi asakisTvis Sesaferisi leqsikoni, zogadi codna da gageba aqvs, xolo 3 wlis asakis Sesaferisad xa-tavs da angariSobs, imis Tqma, rom igi saSualod 5 wlis asa-kis ganviTarebis doneze imyofeba, realobas ar Seesabameba. ufro mizanSewonilia bavSvis fsiqikuri funqcionirebis Sefaseba, misi Zlieri da susti mxareebis aRwera. es bevrad ufro informatulia mSoblebisa da maswavleblebisaTvis.

ra iwvevs viliamsis sindroms? gaurkveveli mizezis gamo viliamsis sindromis mqone

adamianebs ara aqvT genetikuri masala me-7 qromosomaze im genis CaTvliT, romelic cilis elastins qmnis. elastinis genis nakleboba, SeiZleba, viliamsis sindromis bevri fizi-kuri maxasiaTeblis mizezi iyos.

viliamsis sindromis mqone piridan STamomavlobaze am sindromis gadacemis riski 50%-ia.

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ramdenad xSirad gvxvdeba viliamsis sindromi?populaciaSi aRniSnuli sindromis gamovlenis sixSire

dabalia: yovel �0 aTas axalSobilze _ � bavSvi. sindromi Tanabrad vlindeba orive sqesSi.

ra ZiriTadi problemebi gvxvdeba viliamsis sindromis dros?• dabadebidan pirveli ramdenime Tvis ganmavlobaSi axal-

Sobils aqvs tkivilebi da Zilis darRveva. bavSvi ver iZinebs, gamudmebiT tiris, Sewuxebulia. 6 Tvis, an erTi wlisaTvis es mousvenroba da tkivilebi qreba.

• bavSvebs uWirT moZraobebis koordinacia, balansis dac-va. xelebis moZraoba uxerxuli da mouqnelia, uWirT fanqris, kalmis xmareba.

• mniSvnelovani problemaa xmebisadmi maRali mgrZnobelo-ba, rac bavSvis SfoTvasa da SiSs iwvevs, gansakuTrebiT, Tu xmebi moulodneli da ucnobia.

• didi problemaa reJimis moulodneli cvlilebebi, daugegmavi movlenebi, romlebic bavSvis SfoTvas iwvevs.

• swavlisas gvxvdeba yuradRebis koncentraciis sirTule da gafantuloba.

• mniSvnelovani problemaa sivrciTi orientacia: bavSvebs uWirT marjvena-marcxena mxaris garCeva, isrebiani saa-Tis cnoba, obieqtebis sivrciTi mimarTebebis cnoba.

• ariTmetikuli operaciebis aTvisebis sirTule.

SeiZleba Tu ara viliamsis sindromis gankurneba? dReisaTvis sindromis mkurnalobis taqtika jer kidev

Camouyalibebelia. Tumca, warmatebulia simptomuri mkur-naloba im SemTxvevaSi, rodesac bavSvs romelime samedicino problema aqvs.

diagnozi dgindeba dezoqsiribonukleinis mJavis (dnm) genetikuri analizis safuZvelze, rodesac me-7 qromosoma-Si vlindeba elastinis nakleboba.

viliamsis sindromis mkurnalobaSi metad efeqturia fi-zikuri Terapia, okupaciuri Terapia, metyvelebis Terapia bavSvis msxvili da natifi motorikisa da metyvelebis pro-blemebis mosagvareblad. qceviTi problemebis SemTxvevaSi ki mizanSewonilia fsiqologiuri Careva.

3�0

rogori swavlebaa ukeTesi viliamsis sindromis mqone bavSvisaTvis?

bavSvis individuri SesaZleblobebisa da unarebis Sefa-sebis safuZvelze ganisazRvreba swavlebis strategia: igi swavlobs zogadsaganmanaTleblo, an specialur klasSi, zo-gierT SemTxvevaSi ki specialur skolaSi. viliamsis sin-dromis mqone bavSvebs, iseve rogorc yvela danarCen bavSvs, sakuTari individualoba, niWi da interesebi aqvT. Tumca, mainc unda aRiniSnos maTi is fsiqikuri Taviseburebebi, rac xels Segviwyobs efeqtur swavlebaSi.

viliamsis sindromis mqone bavSvebis swavlebisaTvis Zlier sferoebs warmoadgens:

• kargi eqspresiuli metyveleba: sityvebisa da frazebis mravalferovneba;

• kargi xangrZlivi mexsiereba: miuxedavad imisa, rom bavS-vs SeiZleba uWirdes axali informaciis aTviseba, mas igi didxans ar aviwydeba, garda sivrciTi orientaciisa;

• kargi mxedvelobiTi aRqma: didi informaciis miRebis unari TvalsaCino masalidan. suraTebi, fotoebi, ilus-traciebi kargad gamoiyeneba rogorc verbaluri swav-lebis damxmare saSualebebi;

• kargi xanmokle da xangrZlivi smeniTi mexsiereba. ukve skolamdeli asakis bavSvebs zedmiwevniT zustad axsovT simRerebis, moTxrobebisa da zRaprebis teqstebi ise, rom SeuZliaT zepirad miyvnen teqsts;

am unarebze dayrdnobiT SeiZleba iseTi saswavlo piro-bebis Seqmna, romelSic viliamsis sindromis mqone bavSvi Se-Zlebs sirTuleebis gadalaxvas.

• Tvlis operaciebis aTvisebisas aucilebelia TvalsaCi-noebis gamoyeneba _ naxatebis, realuri sagnebis.

• kiTxvis swavleba sjobs naxatebis saSualebiT, romle-bsac qvemoT sityvebiT aRniSvnac eqneba TandarTuli. asoebis swavlasTan erTad, bavSvisaTvis sasargebloa mTliani sityvis daTvaliereba da suraTze gamosaxuli

3��

obieqtis xmamaRla dasaxeleba. bavSvis kargi mxedvelo-biTi da smeniTi mexsiereba mniSvnelovnad gvexmareba kiT-xvis swavlebaSi.

• sivrciTi orientaciis gasaumjobeseblad saWiroa muSa-oba daviwyoT realuri aRqmis sferodan: pirvel rigSi vaswavloT sakuTari sxeulis mxareebis aRqma, Semdeg ki realuri sagnebisa da maTi sivrciTi mimarTebebis ga-moyeneba (kata skamze, kata skamis qveS da a.S.). mxolod amis Semdeg iqneba SesaZlebeli naxatebsa da sivrciT warmodgenebze gadasvla.

3��

myife X sindromi

ra aris myife X sindromi?

myife X sindromi qromosomuli sindromia, romlis drosac X qromosoma Seicavs defeqtur gens, ris gamoc X qromosomis struqtura tydeba da mikroskopSi moCans misi mtvrevadi, myife monakveTi.

mamakacebSi es sindromi ufro mkveTrad vlindeba, vidre qalebSi, radgan qalebs ori X qromosoma aqvT da Tu erT-erTi maTgani dazianebul gens Seicavs, meore, normaluri struqturis mqone X qromosoma, dazianebuli genis kompen-sacias axdens. myife X sindromi vlindeba fizikur, Semecne-biT da qceviT maxasiaTeblebSi. bavSvebs SeiZleba hqondeT specifikuri fizikuri niSnebi, gulis paTologiebi, Semaer-Tebeli qsovilis paTologia, daswavlis unaris darRveva, gonebrivi CamorCenilobis sxvadasxva xarisxi, SeiZleba ga-movlindes autisturi speqtris aSlilobisTvis damaxasia-Tebeli simptomebi an agresiuli qcevac. paTologiuri niS-nebis gamoxatulebis xarisxi damokidebulia genis nawilo-briv, an mTlian mutaciaze. mTliani mutaciis SemTxvevaSi sindromis niSnebi ufro mkafiodaa gamoxatuli.

sindromi pirvelad �943 wels aRweres Martin-ma da Bell-ma erT-erTi ojaxis magaliTze, sadac mamakac naTesavebs hqondaT specifikuri fsiqikuri niSnebi da gonebrivi Ca-morCeniloba. amitom aRniSnul mdgomareobas martin-belis sindromsac uwodeben.

riT xasiaTdeba myife X sindromi?fizikuri niSnebi:

SesaZlebelia, sindromisaTvis damaxasiaTebeli fiziku-ri niSnebi TvalSisacemi ar iyos, magram am sindromis mqone bavSvebs, rogorc wesi, aReniSnebaT: grZeli saxe, didi Tavi, farTo da win wamoweuli yurebi, biWebs _ didi saTesle jirkvlebi, brtyeli terfi, msxvili, win wamoweuli nikapi, gulis, gansakuTrebiT marcxena parkuWis sarqvlis paTolo-gia, Sezrdili ori TiTi, SemaerTebeli qsovilis paTolo-gia. xSiria qronikuli Sua yuris anTeba, CvilobaSi gastro-ezofaguli refluqsi.

3�3

SemecnebiTi Taviseburebebi: myife X sindromis mqone bavSvebSi SemecnebiTi sferosa

da Sesabamisad, gonebrivi ganviTarebis gansxvavebuli pro-filebi gvxvdeba. umravlesobas ioli gonebrivi CamorCeni-loba aqvs (biWebis 80%-s da gogonebis 35%-s). • bavSvebis umetesobas aReniSneba metyvelebis Seferxeba:

maTi metyveleba mokle frazebiT xasiaTdeba, wyvetilia, xSirad imeoreben sityvebs da frazebs (perseveracia), pasuxoben impulsurad, metyveleba atarebs qaotur xa-siaTs _ bavSvi ver inarCunebs saubris Temas da uadgi-lod CaurTavs sxva Sinaarsebs; bavSvebi xSirad iyeneben avtomatizebul frazebs, uWirT semantikuri kavSirebis gageba (drois, Tanmimdevrobis, sivrciTi mimarTebebis aRmniSvneli sityvebis).

• maTi leqsikoni da sintaqsi Seesabameba asakobriv nor-mas, gaaCniaT verbaluri da qceviTi imitaciis gaZliere-buli unari.

• bavSvebs uWirT saubris dawyeba, SekiTxvis dasma. metyve-lebis tempi swrafia, riTmi _ araTanabari. SeiZleba, hqondeT oraluri dispraqsia, anu uWirdeT enis, loye-bis, tuCebisaTvis Sesabamisi pozis micema.

• bavSvebs darRveuli aqvT sensoruli integracia: isini zed-metad mgrZnobiareni arian Sexebis, xmebis, gemos gamRiziane-blebis mimarT; SeiZleba hqondeT sxvadasxva xmis, garkveuli moZraobebis SiSi; SeiZleba, ar uyvardeT garkveuli tipis saWmeli. garemo stimulebis mimarT moWarbebuli mgrZno-biaroba bavSvisaTvis Semawuxebeli da damTrgunvelia. man ar icis rogor unda gaumklavdes usiamovno SegrZnebebs, rac, SeiZleba, araadekvaturi qcevis mizezi gaxdes.

• bavSvebi bevrad ukeTesad amuSaveben vizualur informa-cias, vidre smeniTs. amitom advilad swavloben kiTxvas, maSin, roca wakiTxulis gageba uWirT.

• aseTi bavSvebisaTvis problemaa ariTmetikuli opera-ciebis aTviseba.

• myife X sindromis mqone bavSvebs uWirT axal, proble-mur situaciasTan Segueba; isini met warmatebas aRweven iseT situaciaSi, romelic winaswar dagegmili da struq-turirebulia.

3�4

• myife X sindromis mqone yvela biWsa da gogonebis �/3-s yuradRebis mniSvnelovani problemebi aqvT. maT uWirT rogorc yuradRebis koncentracia, aseve misi swrafi ga-datana. amave dros, bavSvi SeiZleba iyos hiperaqtiuri: impulsuri, mousvenari, gafantuli da amis gamo swavla-Si Seeqmnas problemebi.

qceviTi maxasiaTeblebi:• myife X sindromis mqone bavSvebs, SeiZleba, hqondeT

socialuri, megobruli, mSvidi damokidebuleba garSe-momyofTa mimarT. amave dros, bevri gamRizianebeli, xmauri Tu xalxmravloba iwvevs maT gaRizianebasa da SfoTvas.

• bavSvs, SeiZleba, hqondes autisturi tipis qceva: Tva-lebiT kontaqtis sirTule, ar siamovnebdes pirdapiri mzera, moswondes ganmeorebadi moqmedebebi (mag. taSi, fexebis bakuni), uyvardes triala sagnebis yureba.

• biWebs xSirad axasiaTebT guneba-ganwyobis cvalebadoba, agresiuli afeTqebebi. feTqebad qcevas xels uwyobs ga-reSe stimulebze Zalian maRali mgrZnobiaroba. amitom garemosa Tu situaciis mowyobasa da struqturirebas didi mniSvneloba aqvs aseTi qcevis Sesamcireblad. gogonebis SemTxvevaSi guneba-ganwyobis arastabiluroba vlindeba advilad gaRizianebadobasa da depresiul simptomebSi.

• myife X sindromis dros xSiria SfoTvis maRali done, gansakuTrebiT axal situaciaSi. SeiZleba adgili hqondes panikur Setevebsac.

• xSiria akviatebuli azrebi da iZulebiTi moqmedebebi, gansakuTrebiT qalebSi.

ra iwvevs myife X sindroms?�969 wels Lubs-ma aRmoaCina X zedmeti genetikuri masa-

la qromosomis grZeli mxarze. mas Semdeg, intensiuri ge-netikuri kvlevebis safuZvelze dadginda, rom aRniSnuli sindromi gamowveulia X qromosomaze FMR-1 genis mTliani an nawilobrivi mutaciiT. am genis garkveuli monakveTi Sei-cavs fuZe-nukleotidebs Semdegi TanmimdevrobiT: citozi-

3�5

ni, guanini, guanini _ CGG. es ganmeorebadi Tanmimdevroba iZleva FMR-1 genis mutaciis dadgenis saSualebas. FMR-1 geni niSnavs: myife X gonebrivi CamorCeniloba-�. mis sigrZe-Si CGG Tanmimdevrobis gameoreba SeiZleba iyos 6-dan �00 da meti. visac ara aqvs myife X-is matarebeli geni, CGG ga-meorebaTa raodenoba 6-dan 54-ia. yvelaze xSiria saSualod �9 gameoreba. pre-mutacia gulisxmobs FMR-1 genis monak-veTSi CGG Tanmimdevrobis 50-dan �00-mde gameorebas. aseTi struqturis mqone adamianebi myife X qromosomis matareb-lebi arian, magram TviTon ar gaaCniaT myife X qromosomis sindromisaTvis damaxasiaTebeli gamovlinebebi.

sruli mutacia gulisxmobs FMR-1 genSi CGG Tanmimde-vrobis �00-ze met gameorebas. aseTi genis mqone mamakacebi-dan yvela maTgans aqvs gamoxatuli myife X sindromi, qale-bidan ki mxolod naxevars. aris mozaicizmis SemTxvevebi, ro-desac zogi ujredis X qromosomaSi FMR-1 genis garkveul monakveTze CGG gameoreba SeiZleba 90-mde iyos, xolo sxva ujredebis X qromosomaSi ki _ �00-ze meti. mozaicizmis mqo-ne pirebs aRniSnuli sindromi SedarebiT rbilad da iolad aqvT gamoxatuli. FMR-1 geni gamoimuSavebs specifikur ci-las, romelic gavlenas axdens tvinis neironebis funqcioni-rebaze; rodesac es cila mcire raodenobiT, an saerTod ar aris, adamians gonebrivi CamorCeniloba uviTardeba. radgan mamakacebs erTi X qromosoma aqvT da aRniSnuli sindromi swored X qromosomis dazianebisas vlindeba, es daavadeba mamakacebSi ufro xSirad gvxvdeba, vidre qalebSi. fsiqikur ganviTarebaSi CamorCena aReniSneba X qromosomis FMR-1 genis sruli mutaciis mqone qalebis mxolod naxevars. qalisaTvis, romelic myife X qromosomis matarebelia, 50%-ia albaToba, rom misi yvela Svili myife X qromosomis matarebeli iqneba; sindromis gamomJRavnebis albaToba kidev ufro izrdeba mamrobiTi sqesis Svilebis SemTxvevaSi.

ramdenad xSiria myife X sindromi?populaciaSi daaxloebiT �59 qalidan �-ia myife X qro-

mosomis pre-mutaciuri genis an sruli mutaciis mqone genis matarebeli. pre-mutaciuri genis matarebel qalebs myife X sindromis niSnebi fenotipurad ar uvlindebaT. sruli

3�6

mutaciis mqone genis matarebeli qalebidan ki naxevars aqvs sindromis gamoxatuli niSnebi.

aSS monacemebiT yovel 4000 mamakacze da yovel 8000 qalze gvxvdeba � myife X qromosomis sindromiT daavade-buli. myife X sindromi ��-e qromosomis trisomiis Semdeg gonebrivi CamorCenilobis yvelaze gavrcelebuli geneti-kuri mizezia.

raSi mdgomareobs myife X sindromis ZiriTadi problemebi?• metyvelebis ganviTarebis Seferxeba, romelic metyve-

lebis Terapevtis Carevas saWiroebs. bavSvebs gansaku-Trebuli problema aqvT smeniT aRqmaSi, rTuli grama-tikuli konstruqciebis gagebaSi. metyveleba qaotur xasiaTs atarebs da mowesrigeba esaWiroeba, aRiniSneba eqolaliebi.

• yuradRebis koncentraciisa da gadanacvlebis sirTule, rac bavSvs swavlis procesSi uSlis xels. impulsurobi-sa da gafantulobis gamo bavSvi smeniT miRebul infor-macias ver igebs, cudad imaxsovrebs.

• hiperaqtivoba.• sirTuleebi ariTmetikuli operaciebis aTvisebaSi.• sensoruli integracis darRveva da garemo gamRiziane-

blebis mimarT zedmeti mgrZnobiaroba bavSvs xels uS-lis adekvaturi kontaqtis damyarebaSi, urTierTobaSi, socialurad miRebuli qcevis ganxorcielebaSi.

• �5%-Si autisturi tipis qceva, rac TvaliT kontaqtis da komunikaciis simwireSi, cvlilebebisadmi rezisten-tobaSi gamoixateba.

• SfoTvis maRali done da guneba-ganwyobis arastabilu-roba arTulebs bavSvis garemosTan Seguebas, axal situ-aciaSi adekvatur qcevas.

• �0%-s aReniSneba epilefsiuri gulyrebi da saWiroebs antikonvulsantebiT mkurnalobas.

3�7

rogor aris SesaZlebeli myife X sindromis diagnostireba?• pirvel rigSi, unda moxdes sindromis zusti genetikuri

diagnostireba. SesaZlebelia myife X sindromis prena-taluri diagnostika Semdegi meTodiT: orsulobis me-�0 kviras amniocentezis saSualebiT iReben sinjs sanayofe siTxidan da amowmeben X qromosomis mutacias. bavSvebsa da mozrdilebSi sindromis diagnostireba SesaZlebelia dnm-is pirdapiri analiziT, rodesac dgindeba FMR-� ge-nis monakveTis mutacia masSi nukleotidebis CGG gan-meorebadi Tanmimdevrobis identifikaciiT.

• adreul bavSvobaSi am mdgomareobaze eWvis SemTxvevaSi aucilebelia genetikuri analizis Catareba.

• metad mniSvnelovania ojaxuri istoria: anamnezSi sayu-radReboa daswavlis unaris daqveiTebis mqone an ioli gonebrivi CamorCenilobis mqone deda, ojaxis wevrebi ataqsiiT da tremoriT, aseve dedis sakvercxeebis dis-funqciiT gamowveuli meoradi uSviloba.

rogor SeiZleba davexmaroT myife X sindromis mqone pirebs?• aucilebelia nevrologis, kardiologis, otolaringo-

logis, gastroenterologis detaluri gamokvlevebi, Tanmxlebi problemebis identifikaciisa da drouli mkurnalobisaTvis.

• diagnozis dadgenisTanave, rac SeiZleba adreuli asaki-dan, aucilebeli da efeqturia sensomotoruli stimu-lacia da okupaciuri Terapia, romelic bavSvs mouwe-srigebs gamRizianeblebsa da moZraobebze araadekvatur reaqciebs.

• bavSvisaTvis didi daxmarebaa mokle, martivi winadade-bebiT mimarTva, radganac smeniTi mexsierebis moculoba SezRuduli aqvs; metyvelebis ganviTarebisaTvis mniSv-nelovania erToblivi moqmedebis dros, auCqarebeli, Cveulebrivi tempiT saubari imaze, Tu ras akeTeben, ra sagnebs iyeneben, ra xdeba garSemo.

• maRali SfoTvisa da agresiulobis Sesamcireblad kar-gi saSualebaa bavSvis winaswari momzadeba axali situa-

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ciisaTvis, miTiTebebis micema imis Sesaxeb, Tu ra unda gakeTdes da ras unda moelodes. aucilebelia mSvi-di, struqturirebuli situacia, romelic mkveTrad ar icvleba, aseve xelisSemSleli gamRizianeblebis SezRu-dva: xmauris, xalxmravlobis, xmamaRali musikis da a.S.

• bavSvs swavlaSi mniSvnelovnad exmareba naxatebiani masa-lis gamoyeneba da informaciis mxedvelobiT miwodeba, radganac aseT bavSvebs kargad aqvT ganviTarebuli mxe-dvelobiTi mexsiereba.

• vinaidan bavSvebs kargi mibaZvis unari da iumoris Sesa-niSnavi grZnoba aqvT, efeqturi daxmarebaa maTTan ara individualuri, aramed jgufuri muSaoba. verbaluri da qceviTi mibaZvis SesaniSnavi unari, rac iZleva sasurve-li qcevis modelirebis saSualebas, SeiZleba, efeqtu-rad gamoviyenoT aseTi bavSvebis swavla-aRzrdis pro-cesSi.

SeiZleba Tu ara gankurneba?jer-jerobiT, am sindromisagan gankurneba SeuZlebelia.

Tumca, arsebobs sxvadasxva saxis mkurnaloba, romlebic mi-marTulia myife X sindromis simptomebis Sesamsubuqeblad da bavSvis socialur garemosTan adaptirebis gasaumjobe-seblad. mkurnaloba moicavs rogorc medikamentur, aseve aramedikamentur Terapias. medikamentebis daniSvna xdeba mZimed gamoxatuli emociuri sferos darRvevebis, depre-siis, maRali SfoTvis, feTqebadi agresiuli qcevis SemTxve-vebSi eqimis mier.

bavSvis fsiqikuri ganviTarebis xelSewyobis, Semecnebi-Ti da emociuri sferos ganviTarebis mizniT bavSvisaTvis aucilebelia metyvelebis Terapia, okupaciuri Terapia, fizikuri Terapia, fsiqologiuri konsultacia, specialu-ri swavleba da individualuri samkurnalo fsiqologiur-pedagogiuri programebi, romlebic iqmneba bavSvis Zlieri da susti mxareebis, unarebisa da interesebis gamovlenis mixedviT. aRniSnuli mimarTulebiT aqtiuri muSaoba bavSvis ganviTarebis aucilebeli pirobaa.

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rogor vaswavloT myife X sindromis mqone bavSvs?aRniSnuli sindromis mqone bavSvebis SemecnebiTi Tavi-

seburebebidan gamomdinare, aseT bavSvebs esaWiroebaT gan-sakuTrebuli saswavlo garemo. bavSvebi kargad iTviseben miwodebul masalas da uadvildebaT swavla, Tu:• masala miewodebaT maqsimaluri TvalsaCinoebiT da ga-

moiyeneba mravalferovani vizualuri masala; • gamoiyeneba vizualuri stimulebi smeniTi yuradRebis

gasamaxvileblad;• bavSvs eZleva martivi instruqciebi;• gamoiyeneba bavSvis kargi imitaciis unari. ramdenjerme

aCveneben moqmedebas sagnebiT, moZraobas, umeoreben frazebs an sityvebs, rac SeiZleba, melodiurad da ga-moTqmiT;

• muSaoben ramdenime bavSvTan erTdroulad da ara indi-vidurad;

• hiperaqtivobis problemis dasaZlevad gakveTils ramde-nime mcire nawilad yofen, mokle SesvenebebiT, rodesac gamoiyeneba motoruli funqciis ganmaviTarebeli savar-jiSoebi musikis, an ritmis TanxlebiT;

• xdeba bavSvis metyvelebis yovelgvari mcdelobis waxa-liseba; bavSvs aZleven imden dros, ramdenic esaWiroeba kiTxvaze pasuxis gasacemad;

• saWiroebis SemTxvevaSi, bavSvis swavlebis efeqturobis gazrdis mizniT, aucilebelia metyvelebis Terapevtisa da okupaciuri Terapevtis daxmareba;

• bavSvs mowesrigebuli da gansazRvruli aqvs dRis re-Jimi; miCveulia yoveldRiuri saskolo Tu saSinao aq-tivobebis Tanmimdevrobas.

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fenilketonuria

ra aris fenilketonuria?fenilketonuria aris nivTierebaTa cvlis, kerZod, ami-

nomJava fenilalaninis cvlis memkvidreobiTi darRveva, romelsac Tan sdevs gonebrivi CamorCeniloba da sxvadasxva nevrologiuri simptomi.

daavadeba pirvelad aRiwera �934 wels norvegieli eqi-mis felingis mier. igi gadaecema autosomur-recesiuli gziT, rac niSnavs, rom fenilketonuriis mqone bavSvis ori-ve mSobeli dazianebuli genis faruli matarebelia da aseT SemTxvevaSi fenilketonuriis mqone bavSvis dabadebis alba-Toba �5%-ia, anu yoveli 4 mSobiarobidan �.

ra axasiaTebs fenilketonurias?xSirad, dabadebidan pirveli sami Tvis ganmavlobaSi,

bavSvs araferi emCneva da specialuri analizis gareSe rai-mes dadgena rTulia. zogierT SemTxvevaSi bavSvebs dabade-bidanve aReniSnebaT maRali agznebadoba (umizezo tirili, Zilis darRveva), an piriqiT, Zilianoba, moTenTiloba. me-4 Tvidan SeimCneva CamorCena bavSvis fsiqikur ganviTarebaSi. bavSvi xdeba indiferentuli mSoblebis, saTamaSoebis mi-marT. droulad ver jdeba, ver dgeba, metyvelebis ganvi-Tareba Zlier CamorCeba. bavSvebis 9�%-s uviTardeba mZime xarisxis gonebrivi CamorCeniloba, 3-4%-s ki ioli xaris-xis gonebrivi CamorCeniloba; aseTi bavSvebis 0.�-0.3%-is fsiqikuri ganviTareba normis farglebSia. 5-6 wlis asakis Semdeg gonebrivi CamorCeniloba stabilur xasiaTs iRebs. xSirad adgili aqvs qcevis darRvevas, Zlier agznebas mot-oruli stereotipebiT, xandaxan _ fsiqotur simptomebsac. bavSvebSi � wlidan xSiria krunCxviTi gulyrebi (50%) da maTi aRmoceneba emTxveva kvebis racionSi cilovani sakvebis CarTvas. 3-5 wlisaTvis krunCxviTi gulyrebis sixSire kle-bulobs da zog SemTxvevaSi mkurnalobis gareSec qreba.

bavSvisaTvis damaxasiaTebelia Warbi oflianoba da spe-cifikuri suni. oTaxSic ki, sadac aseTi bavSvi imyofeba, Taviseburi, obis msgavsi sunia.

amave dros, bavSvs SeiZleba gamouvlindes sxvadasxva

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nevrologiuri simptomatika _ piramiduli da eqstrapira-miduli sistemebis dazianebis niSnebi.

ra iwvevs fenilketonurias?daavadebas iwvevs erT-erTi enzimis, fenilalanin hi-

droqsilazis nakleboba; amis gamo, sakvebTan erTad miRe-buli fenilalanini ar gardaiqmneba Tirozinad, rac iwvevs fenilalaninis dagrovebas sisxlSi da Tav-zurg tvinis siTxeSi. fenilalaninisgan warmoiqmneba fenil-piroyurZ-nismJava da sxva mJavebi, romlebic toqsiurad moqmedeben centralur nervul sistemaze.

raSi mdgomareobs problema?Cveni sakvebi Sedgeba cilebis, cximebisa da naxSirwyle-

bisagan. cilebis safuZvels aminomJavebi warmoadgens; fe-nilalanini ki erT-erTi aminomJavaa, romelsac bavSvis or-ganizmi ver umklavdeba. cilovani sakvebis miRebis Semdeg igi iSleba da yoveli aminomJava, fenilalaninis CaTvliT, sisxlSi Seiwoveba. isini mniSvnelovan rols asrulebs orga-nizmis ganviTarebaSi. bavSvebSi aminonJavebis mniSvnelovani nawili, fenilalaninis CaTvliT, emsaxureba zrdis process. normaluri kvebis pirobebSi zrdisa da qsovilebisaTvis sa-Wiro aminomJavebis raodenoba organizmSi sakmarisze metia. es zedmeti aminomJavebi sxva nivTierebebad (enzimebad) fer-mentebad gardaiqmneba. rogorc wesi, ferment fenilalanin hidroqsilazis zemoqmedebiT Warbi fenilalanini sxva ami-nomJavad _ Tirozinad gardaiqmneba. Tirozinis daxmarebiT organizmSi warmoiqmneba hormonebi, tvinis qimiuri nivTi-erebebi da melaninis yavisferi pigmenti.

fenilketonuriis dros organizmSi ferment fenilala-nin hidroqsilazis ukmarisobis an saerTod uqonlobis gamo, ver xerxdeba fenilalaninis gardaqmna Tirozinad, amitom sisxlSi igi didi raodenobiT grovdeba, gardaiqmneba fe-nilketonebad da gamoiyofa Sardis meSveobiT. aRniSnuli fermentis deficiti memkvidruli warmoSobisaa. erTi de-feqturi genis matarebeli mSoblebis Svilebs, SeiZleba, ar hqondeT fenilketonuria, radgan wyvilidan erT-erTi janmrTeli geni, SesaZloa, sakamarisad akontrolebdes fe-nilalanin hidroqsilazis warmoSobas da aseTi defeqturi

3��

genis matarebeli 50-dan � adamiania. orive mSobelSi TiTo defeqturi genis arsebobis SemTxvevaSi daavadebis ganviTa-rebis albaTobaa �500-dan � da aseTi Tanxvedrisas fenil-ketonuriis mqone bavSvis dabadebis albaToba yovel or-sulobaze �5%-ia, fenilketonuriis defeqturi genis mqone bavSvis dabadebis albaToba 50%-i, normaluri genebis mqone bavSvis dabadebis albaToba ki _ �5%.

ramdenad xSiria fenilketonuria?saSualod gvxvdeba �0 000 axaldabadebulidan �-Si. erT-

nairi sixSiriT gvxvdeba gogonebsa da biWebSi. fenilketo-nurias adgili aqvs gonebrivi CamorCenilobis SemTxvevebis �%-Si.

raSi mdgomareobs ZiriTadi problemebi?• mTavar problemas warmoadgens fenilalaninis cvlis

darRveva, sisxlSi misi Warbi raodenobiT dagroveba. didi raodenobis cilebis Semcveli sakvebi;

• ZiriTadi problemaa bavSvis balansirebuli dieta - is-eTi, rom sakvebi ar Seicavdes fenilalanins, ar Sei-cavdes didi raodenobis cilebs, amave dros, iyos kalo-riuli da bavSvis ganviTarebisaTvis aucilebeli yvela nivTierebis Semcveli;

• bavSvis gonebrivi CamorCeniloba da masTan dakavSire-buli bavSvis fsiqikuri ganviTarebisa da swavlis prob-lemebi;

• qcevis darRveva, hiperaqtivoba, gaRizinebadoba, advili agznebadoba, xandaxan fsiqoturi darRvevebi, impul-suroba;

• metyvelebis ganviTarebis CamorCena;• mozrdilebSi xSiria depresia.

rogor SeiZleba davexmaroT fenilektonuriis mqone pirovnebas?

efeqturi daxmareba SesaZlebelia• metad mniSvnelovania adreuli diagnostika. aSS-sa da

evropaSi axaldabadebul bavSvebs masiurad umowmeben fenilalaninis Semcvelobas (skriningi). yvelaze mar-

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tivia SardSi misi Semcvelobis gasinjva samqloriani rkinis FeCl 5% xsnarisa da ZmarmJavas ramdenime wveTis saSualebiT. Sardi mwvaned iRebeba, Tu fenilalanini normaze metia (felingis sinji). fenilalanins gansaz-Rvraven sisxlis plazmaSic; zust meTodad miiCneva ga-tris mikrobiologiuri testi: sisxlSi fenilalaninis Semcveloba ar unda aRematebodes �-6 mg/dl. adreuli diagnostika aucilebeli pirobaa bavSvis normaluri ganviTarebis uzrunvelsayofad.

• ZiriTadi daxmarebaa bavSvis balansirebuli kvebis di-etis SerCeva cilovani sakvebis mkveTri SemcirebiT. pro-teinebiT mdidari sakvebis miReba an mkacrad izRudeba, an saerTod ikrZaleba. magram fenilketonuriis mqone bavSvsac esaWiroeba garkveuli raodenobis cilebi da fenilalanini. misi Zlieri daqveiTebac mavnea organizmi-saTvis. bavSvebs mcire raodenobiT aZleven dedis rZes, xilis, bostneulis wvenebsa da fafebs. dietaSi Sedis TiTqmis yvela xili, bostneulidan kombosto, stafilo, Warxali. agreTve Tafli. racionidan amoRebulia xor-ci, Tevzi, kvercxi, xaWo, yveli, lobio, cercvi, nigozi. rZe da katrofili ki mkveTrad SezRudulia.

• mudmivi dieta bavSvis normaluri ganviTarebis garan-tiaa. mas aRar Camouyalibdeba gonebrivi CamorCeniloba, ar ganuviTardeba nevrologiuri simptomebi. aRniSnuli dieturi daxmareba qronikuli xasiaTisaa da misi Sew-yveta ar SeiZleba. winaT fiqrobdnen, rom dietis Sewyve-ta SesaZlebelia �0-�� wlis asakisaTvis. magram gamokv-levebma aCvena, rom dietis Sewyvetis Semdeg adamianebs nervuli aSlilobebi ewyebaT. amitom aucilebelia xan-grZlivi dieta.

• aucilebelia bavSvis sisxlis regularuli Semowmeba fe-nilalaninis donis gansazRvris mizniT.

• bavSvis fsiqikuri ganviTarebis CamorCenis SemTxvevaSi, aucilebelia, misi specialuri fsiqologiuri da peda-gogiuri daxmareba.

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SeiZleba Tu ara fenilketonuriis gankurneba?sruliad SesaZlebelia. mkurnaloba xdeba dietis saSu-

alebiT, romelic cilebis minimalur raodenobas Seicavs. bavSvma zrdisaTvis saWiro raodenobis fenilalanini rom miiRos, dietaSi unda CairTos specialuri sabavSvo sakvebi, romelic damzadebulia cilis kompozitebze. es aris ci-lis hidrolizatebi _ cimogrini, ketonili, lofenoraki, aseve alfa-aminomJavis narevebi, askorbinis mJava. sinTetu-ri formula gamoiyeneba akrZaluli sakvebis Sesacvlelad. igi sakmaod ZviradRirebulia, magram danaxarji Sedegs amarTlebs. Tu bavSvs dieta droulad eniSneba, mas aravi-Tari problemebi ara aqvs. drouli dieta �00%-iT iZleva normaluri fizikuri da fsiqikuri ganviTarebis garantias, radganac sisxlSi fenilalaninis Semcveloba daregulire-bulia. dietis dacvis SemTxvevaSi fenilketonuriis mqone qals Tavisuflad SeuZlia iyolios bavSvi. rodesac aseTi qalis meuRle defeqturi genis mtarebeli ar aris, maTi bavSvi janmrTeli daibadeba.

SeuZliaT Tu ara muSaoba fenilketonuriis mqone pirebs?

sisxlSi fenilalaninis kontrolisa da dietis fonze bavSvebi kargad swavloben, SemdgomSi sakuTari survili-samebr euflebian nebismier profesias da warmatebiT mu-Saoben.

gonebrivi CamorCenilobis mqone pirebs, gansxvavebuli SesaZleblobebis gamo, zogierT SemTxvevaSi SeuZliaT da-moukideblad, zogierT SemTxvevaSi ki _ zedamxedvelobis qveS muSaoba.

3�5

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